Early extubation after elective surgical aortic valve replacement during the COVID-19 pandemic

• Published in: Journal of cardiothoracic surgery 2024-08, Vol.19 (1), p.490-10
• Main Authors: Fischbach, Anna, Simons, Julia Alexandra, Wiegand, Steffen B, Ammon, Lieselotte, Kopp, Rüdger, Marx, Gernot, Rossaint, Rolf, Akhyari, Payam, Schälte, Gereon
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Airway Extubation; Analysis; Angina pectoris; Aorta; Aortic stenosis; Aortic valve; Aortic Valve - surgery; Aortic valve stenosis; Aortic Valve Stenosis - surgery; Bacterial pneumonia; Cardiovascular disease; Care and treatment; Coronary vessels; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Early extubation; Elective Surgical Procedures; Enhanced recovery after cardiac surgery; Epidemics; ERACS; Extubation; Female; Germany - epidemiology; Health aspects; Heart; Heart surgery; Heart Valve Prosthesis Implantation - methods; Heart valves; Hospitals; Humans; Length of Stay - statistics & numerical data; Life expectancy; Male; Medical research; Medicine, Experimental; Middle Aged; Mortality; Pandemics; Patients; Pneumonia; Postoperative Complications - epidemiology; Recovery (Medical); Retrospective Studies; SARS-CoV-2; Software; Statistical analysis; Sufentanil; Surgery; Surgical aortic valve replacement
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-02989-0

Surgical aortic valve replacement (SAVR) is an established therapy for severe calcific aortic stenosis. Enhanced recovery after cardiac surgery (ERACS) protocols have been shown to improve outcomes for elective cardiac procedures. The COVID-19 pandemic prompted early extubation post-elective surgeries to preserve critical care resources. To investigate the effects of extubating patients within 6 h post-elective SAVR on hospital and ICU length of stay, mortality rates, ICU readmissions, and postoperative pneumonia. The retrospective analysis at the University Hospital Aachen, Germany, includes data from 2017 to 2022 and compares a total of 73 elective SAVR patients. Among these, 23 patients were extubated within 6 h (EXT group), while 50 patients remained intubated for over 6 h (INT group). The INT group experienced longer postoperative ventilation, needed more vasopressor support, had a higher incidence of postoperative pneumonia, and longer ICU length of stay. No significant differences were noted in overall hospital length of stay, mortality, or ICU readmission rates between the groups. This study demonstrates that early extubation in high-risk, multimorbid surgical aortic valve replacement patients is safe, and is associated with a reduction of pneumonia rates, and with shorter ICU and hospital length of stays, reinforcing the benefits of ERACS protocols, especially critical during the COVID-19 pandemic to optimize intensive care use.