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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.
CONCLUSIONS: A"fast-track" pathway may be applied in selected elderly high-risk patients. Age alone should not exclude consideration for "fast-track" management.
