Feasibility and outcomes of Enhanced Recovery after Surgery (ERAS) Protocol in patients undergoing Trans-catheter Aortic Valve Replacement (TAVR)

AL Abbasi, Baher

Feasibility and outcomes of Enhanced Recovery after Surgery (ERAS) Protocol in patients undergoing Trans-catheter Aortic Valve Replacement (TAVR)

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Baher AL Abbasi, M.D. , 1. University Of Miami/JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Pradeep Dayanand, M.D. , 1. University Of Miami/JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Nakeya Dewaswala, M.D. , 1. University Of Miami/JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Gustavo Avila , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, west pal beach, FL

Pedro medical Torres , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, west pal beach, FL

Jesus E. Pino, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Lawrence Lovitz, M.D. , JFK Medical Center, Atlantis, FL

Mark Rothenberg , University of Miami Palm Beach Regional Campus, Atlantis, FL

Marcos Nores, MD , JFK Medical Center, Atlantis, FL

Robert Chait, M.D. , University of Miami Palm Beach Regional Campus, Atlantis, FL

Background
ERAS is a multimodal approach that aims to optimize outcomes after surgery by blunting the response to surgical stressors. Data regarding application of ERAS protocol in transcatheter aortic valve replacement (TAVR) is scarce. Based on prior literature, we defined ERAS protocol as follows: minimal hydration on the day of TAVR with 1-2 L fluid, mean arterial blood pressure of 65-120 mm Hg, fasting blood glucose of 80-180 on the day of procedure, minimally invasive TAVR approach (transfemoral), use of opioid sparing analgesia, minimum anesthesia (3 or less anesthetics not including ketamine), foley catheter and central line removal within 24 hours, physical therapy and diet initiation on same day of procedure. Optimal ERAS was defined if 7 or more of the above criteria were met.

Methods
This is a retrospective cohort study of patients that underwent TAVR between April 2012 and March 2016 at our institution. Primary outcomes included one year mortality and total hospital length of stay. Secondary outcomes were intensive care unit (ICU) length of stay, post-TAVR acute kidney injury (AKI), stroke and infection.

Results
Out of 354 patients that underwent TAVR in our institution, 156 (44%) were female, with mean age of 84.66 ± 7.07. ERAS protocol was optimally applied in 90 (25.4%) patients. The incidence of one year mortality noted in the patients that ERAS protocol was applied was 7/90 with a mean of 4.8 (95% CI 4.4-5.2) vs 44/ 264, with mean of 5.42 (95% CI 5.2-5.5), (p 0.005) in the other group in which ERAS was not employed. The mean hospital length of stay in the ERAS group is 5.45 (95% CI 4.9-6) vs 7.78 (95% CI 7.2-8.3), (p <0.0001). The mean ICU length of stay in the ERAS group is 0.34 (95% CI 0.22-0.46) vs 1.19 (95% CI 0.14-0.9), (p < 0.0001). The mean incidence of acute kidney injury (AKI) post- TAVR is 4.98 (95% CI 4.65-5.31), vs 5.45 (95% CI 5.27-5.64), (p 0.051). The mean incidence of infections post-TAVR in the ERAS group is 4.92 (95% CI 4.41-5.43), vs 5.38 (95% CI 5.21-5.55), (p 0.08). The mean incidence of stroke post TAVR in the ERAS group is 5 (95% CI 3.88-6.11), vs 5.34 (95% CI 5.17-5.50), (p 0.51).

Conclusions
One year mortality, total hospital LOS, ICU LOS, and infection post TAVR were significantly lower in patients in whom the ERAS protocol was applied.