Fast-Track Extubation in Minimally Invasive Cardiac Surgery: Limits and Lessons of a 4-Year Single-Center Analysis

Sebastian Johannes Bauer^1,2*Moritz Benjamin Immohr^1,2Friederike Irmgard Schoettler^1,2Yukiharu Sugimura^1,2Arash Mehdiani^1,2Matthias Thielmann¹Ajay Moza²Anna Fischbach³Michael Knapen⁴Evangelos Karasimos⁴Georg Eberhardt³Gereon Schälte³Rolf Rossaint³Gernot Marx⁴Payam Akhyari^1,2

• ¹Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
• ²Department of Cardiac Surgery, University Hospital RWTH Aachen, Aachen, Germany
• ³Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
• ⁴Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany

Early extubation is a key to enable early mobilization, which, in turn, facilitates early transfer and discharge. However, data on immediate extubation in the operating room outside of an enhanced recovery after surgery (ERAS) concept in minimally invasive cardiac surgery (MICS) are limited.In this propensity score-matched, retrospective, single-center analysis, we compared patients undergoing MICS who were extubated within six hours in the intensive care unit (fast-track, FT) to those extubated in the operating room (extubation in tabula, EIT). Postoperative complications occurred at similar rates in both groups, with intraoperative temperature management identified as a key contributor.Consequently, EIT is safe and feasible even outside of a structured ERAS program. However, our analysis indicates that EIT does not affect the length of hospital stay unless followed by additional interventions (e.g. same day physiotherapy), emphasizing the importance of a multimodal approach of an ERAS protocol. The results are expected to improve within a prospective ERAS program.