Factors associated with an unsuccessful fast-track course following minimally invasive surgical mitral valve repair

Abstract

OBJECTIVES Analyses of fast-track (FT) processes demonstrated that low-risk cardiac surgical patients require minimal intensive care, with a low incidence of mortality or morbidity. We investigated perioperative factors and their association with fast-track failure (FTF) in a retrospective cohort study of patients undergoing minimally invasive mitral valve surgery. METHODS Patients undergoing minimally invasive surgical mitral valve repair for Carpentier type I or type II mitral regurgitation between 2014 and 2020 were included in the study. The definition of FTF consisted of >10 h mechanical ventilation, >24 h intensive care unit stay, reintubation after extubation and re-admission to the intensive care unit. Multivariable logistic regression analysis enabled the identification of factors associated with FTF. RESULTS In total, 491 patients were included in the study and were analysed. Two hundred and thirty-seven patients (48.3%) failed the FT protocol. Multivariable logistic regression analysis showed that a New York Heart Association classification ≥III [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.38–3.08; P < 0.001], pre-existing chronic kidney disease (OR 2.03; 95% CI 1.14–3.70; P = 0.018), coronary artery disease (OR 1.90; 95% CI 1.13–3.23; P = 0.016), postoperative bleeding requiring surgical revision (OR 8.36; 95% CI 2.81–36.01; P < 0.001) and procedure time (OR 1.01; 95% CI 1.01–1.01; P < 0.001) were independently associated with FTF. CONCLUSIONS Factors associated with FTF in patients with Carpentier type I and II pathologies undergoing minimally invasive mitral valve repair are a New York Heart Association classification III–IV at baseline, pre-existing chronic kidney disease and coronary artery disease. Postoperative bleeding requiring rethoracotomy and procedure time were also identified as important factors associated with failed FT.