BACKGROUND: "Fast-track" pathway, which includes the early extubation after operation, early intensive care and hospital discharge, have been successfully used in low- and intermediate-risk patients after all kinds of cardiac surgery. An increase in the number of referrals of older patients for cardiac surgery prompted the present study on the use of a pathway in very high-risk elderly patients undergoing surgical TAVI. Risk factors for the unsuccessful application of the "fast-track" pathway in these patients were determined.
METHODS: We perform retrospective observational study in cardiac surgical department of the large tertiary-care, university-affiliated hospital. All patients who underwent surgical TAVI (transapical, transaortic or transaxyllary) with Edwards SAPIEN heart valve between October 2010 and October 2014 were included.
RESULTS: During the 48-month period, 86 surgical TAVI were performed. The "fast-track" pathway was successful in 34.9% of the patients. On multiple logistic regression analyses, infections problem and acute kidney injury were independently associated with failed early extubation, delayed intensive care unit discharge, and delayed hospital discharge in both groups.
CONCLUSIONS: A "fast-track" pathway may be applied in selected elderly high-risk patients. Age alone should not exclude consideration for "fast-track" management
