Search Results (6)

Purpose: Extubation timing after paediatric cardiac catheterisation under general anaesthesia remains a challenging clinical decision, particularly in children with cyanotic or haemodynamically significant congenital heart disease. This study aimed to evaluate factors associated with non-on-table extubation and to assess early postoperative respiratory outcomes in this high-risk population. Design: This was a single-centre retrospective cohort study conducted in a paediatric cardiac catheterisation laboratory. Methods: Paediatric patients with cyanotic or haemodynamically significant/complex congenital heart disease who underwent cardiac catheterisation under general anaesthesia with endotracheal intubation were included. Patients were grouped according to whether they were extubated on-table in the catheterisation laboratory or transferred to the intensive care unit with ongoing invasive mechanical ventilation. The primary outcome was non-on-table extubation. Secondary outcomes included extubation timing, reintubation within 48 h, major respiratory complications within 48 h, intensive care unit length of stay, hospital length of stay, and 7-day and 30-day mortality. Logistic regression analysis was used to identify factors associated with non-on-table extubation. Findings: Seventy-two patients were included. On-table extubation was performed in 52 patients (72.2%), whereas 20 patients (27.8%) were not extubated on-table. Patients not extubated on-table were younger, had lower body weight, higher American Society of Anesthesiologists physical status IV (ASA IV) frequency, higher Catheterization Risk Score for Pediatrics (CRISP) scores, lower baseline SpO₂, and were more frequently undergoing emergency procedures. Reintubation within 48 h occurred only in the non-on-table extubation group (15.0% vs. 0.0%; p = 0.019). Major respiratory complications within 48 h were more frequent in patients not extubated on-table (20.0% vs. 3.8%; p = 0.047). Intensive care unit and hospital length of stay were also longer in this group. In multivariable analysis, higher CRISP score (adjusted odds ratio 1.22; 95% confidence interval 1.009–1.476; p = 0.040) and emergency procedure (adjusted odds ratio 8.74; 95% confidence interval 1.365–55.927; p = 0.022) were independently associated with non-on-table extubation. No 7-day mortality occurred in either group. Conclusions: On-table extubation after paediatric cardiac catheterisation under general anaesthesia was feasible in most selected patients with cyanotic or haemodynamically significant/complex congenital heart disease. Higher CRISP score and emergency procedures were independently associated with non-on-table extubation. These findings suggest that catheterisation-specific risk assessment may help anticipate postoperative ventilatory requirements in high-risk paediatric cardiac catheterisation patients. Full article

Background: Minimally invasive cardiac valve surgery has emerged as a preferred approach in selected patients, yet optimal postoperative extubation timing remains debated. This systematic review and meta-analysis examined clinical outcomes associated with extubation in the operating room (OR) versus the intensive care unit (ICU) among adult patients undergoing minimally invasive cardiac valve surgery. Methods: The study was conducted according to PRISMA guidelines. A single unit of analysis was applied throughout. Pooled odds ratios were computed with the Mantel–Haenszel random-effects method; where a study reported only a matched or covariate-adjusted estimate, that estimate was reserved for a prespecified sensitivity analysis using the generic inverse-variance method. Results: Five observational studies (2023–2025) including 1101 OR-extubated and 899 ICU-extubated patients from high-volume centers with fast-track or enhanced recovery pathways were included. OR extubation was associated with lower odds of reintubation (OR 0.40; 95% CI 0.24–0.69; I² = 0%), postoperative delirium (OR 0.47; 95% CI 0.31–0.72; I² = 0%), and pneumonia (OR 0.30; 95% CI 0.16–0.53; I² = 0%). No significant differences were observed for new-onset atrial fibrillation, stroke, or reoperation for bleeding. Thirty-day mortality was reported by four of the five studies and comprised few events (5 of 1043 ORE versus 17 of 645 ICE across the four studies reporting this outcome); given the small number of events, the concentration of deaths in the higher-risk ICU-extubated patients, and the reliance of the pooled estimate on two confounded cohorts, this difference is not interpretable as a treatment effect, and no pooled odds ratio is reported here. Length of stay was consistently shorter after OR extubation but was not pooled because of extreme heterogeneity (I² = 96–100%). Sensitivity analyses using adjusted estimates attenuated the associations for reintubation and pneumonia, consistent with substantial confounding by indication. Conclusions: In appropriately selected patients undergoing minimally invasive valve surgery, OR extubation is feasible and is associated with a recovery profile at least comparable to that of ICU extubation. Because extubation location was determined largely by intraoperative and early postoperative stability, these associations should be read as reflecting patient selection rather than a causal benefit of the strategy. The findings support the feasibility of OR extubation in appropriately selected patients at experienced centers and motivate prospective, ideally randomized, evaluation. Full article

Objective: The present study aimed to evaluate the feasibility and safety of performing extubation in the operating room following aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT), as the safety profile of this approach has not been fully established. Methods: We conducted a retrospective analysis of patients who underwent isolated AVR through a RAMT between February 2012 and December 2023. Emergency cases and reoperations were excluded. Patients were categorized according to the location of extubation—either in the operating room (on-table) or in the intensive care unit (ICU). Multivariable logistic regression analysis was used to identify predictors associated with successful on-table extubation. Results: Among 423 patients who underwent non-emergent isolated AVR, 73.3% were extubated in the operating room. This group was characterized by younger age, lower EuroSCORE II, and higher preoperative serum albumin levels. While the surgical techniques did not differ between groups, those extubated on-table had significantly shorter cardiopulmonary bypass times (84.0 [68.0–104.0] vs. 104.0 [85.0–131.5], p < 0.001). Although early postoperative outcomes were comparable, the on-table extubation group had significantly shorter ICU stays (24.0 [22.0–26.0] vs. 25.0 [23.0–30.0], p < 0.001) and hospital stays (5.0 [4.0–6.0] vs. 6.0 [5.0–8.0], p < 0.001). A predictive model incorporating age, albumin levels, and cardiopulmonary bypass time demonstrated a predictive accuracy of approximately 78.4% for on-table extubation success. Conclusions: Extubation in the operating room was found to be both safe and effective for the majority of patients undergoing isolated AVR via RAMT. It was associated with low reintubation rates and significantly reduced lengths of ICU and hospital stays. These findings support the adoption of routine on-table extubation in suitable patients undergoing this procedure. Full article

Background: Postoperative pulmonary complications (PPCs) are the most common complications following lung surgery and can lead to increased postoperative mortality. In this study, we examined the incidence of PPCs, the in-hospital mortality rate, and the risk factors associated with PPCs in patients undergoing open thoracotomy lung resection (OTLR) for reasons other than primary lung cancer. Methods: Data from this multicenter, retrospective study involving 1.368 patients were extracted from the German Thorax Registry and analyzed using univariate and multivariable statistical methods. Results: In total, 278 patients showed at least one PPC. The presence of PPCs was associated with a significantly higher in-hospital mortality rate (7.2% vs. 1.5%; p = 0.000). Multivariable stepwise logistic regression analysis showed absolute age (OR 1.02) and BMI ≤ 19 (OR 2.6) as independent patient-specific risk factors. Significant preoperative risk factors included re-thoracotomy (OR 4.0) and FEV₁ < 60% (OR 2.5). Procedure-related independent risk factors for PPCs included a surgical duration surpassing 195 min (OR 2.7), the continuation of invasive ventilation post-surgery (OR 3.8), and an intraoperative infusion of crystalloids greater than 6 mL/kg/h (OR 1.8). Conclusions: Optimizing intraoperative fluid therapy and on-table extubation when possible may reduce the incidence of PPCs and associated mortality. Full article

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery. Methods: In a monocentric study, we compared a prospective RERACS-group (n = 114) to a retrospective control group (n = 119) (TRIAL Registration (DRKS00031402). The RERACS concept contained multiple perioperative treatment measures such as respiratory training, short fasting, and OTE. The control group received standard care. Results: Primary endpoint: postoperative LOS. Secondary measurements: length of postoperative vasoactive drug support, duration of mechanical ventilation, complication rate, and patient satisfaction on the second postoperative day. RERACS patients showed significantly shorter postoperative length of stay (ICU: 40 ± 34 h vs. 56 ± 51 h, p = 0.005; hospital: 9 ± 4 d vs. 11 ± 6 d, p = 0.028), lower nosocomial infection rates (24% vs. 40%), fewer cases of postoperative cognitive dysfunction ((subsyndromal) delirium 40% vs. 57%), reduced nausea and vomiting (14.9% vs. 32.8%), and faster weaning from catecholamines (22 ± 30 h vs. 42 ± 48 h, p < 0.001), as well as high patient satisfaction. Conclusions: Our study indicated that an ERAS concept with OTE is safe and associated with faster and improved recovery, including lower catecholamine requirements, reduced LOS, and high patient satisfaction in low-risk cardiac surgery. Full article

Background: Enhanced recovery after surgery (ERAS) protocols are utilizing a multidisciplinary approach, reassessing physiology to improve clinical outcomes, reducing length of hospital stay (LOS) stay, resulting in cost reduction. Since its introduction in colorectal surgery. the concept has been utilized in various fields and benefits have been recognized also in adult cardiac surgery. However, ERAS concepts in pediatric cardiac surgery are not yet widely established. Therefore, the aim of the present study was to assess the effects of on-table extubation (OTE) after pediatric cardiac surgery compared to the standard approach of delayed extubation (DET) during intensive care treatment. Study Design and Methods: We performed a retrospective analysis of all pediatric cardiac surgery cases performed in children below the age of two years using cardiopulmonary bypass at our institution in 2021. Exclusion criteria were emergency and off pump surgeries as well as children already ventilated preoperatively. Results: OTE children were older (267.3 days vs. 126.7 days, p < 0.001), had a higher body weight (7.0 ± 1.6 kg vs. 4.9 ± 1.9 kg, p < 0.001), showed significantly reduced duration of ICU treatment (75.9 ± 56.8 h vs. 217.2 ± 211.4 h, p < 0.001) and LOS (11.1 ± 10.2 days vs. 20.1 ± 23.4 days; p = 0.001) compared to DET group. Furthermore, OTE children had significantly fewer catecholamine dependencies at 12-, 24-, 48-, and 72-h post-surgery, while DET children showed a significantly increased intrafluid shift relative to body weight (109.1 ± 82.0 mL/kg body weight vs. 63.0 ± 63.0 mL/kg body weight, p < 0.001). After propensity score matching considering age, weight, bypass duration, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality (STATS)-Score, and the outcome variables, including duration of ICU treatment, catecholamine dependencies, and hospital LOS, findings significantly favored the OTE group. Conclusion: Our results suggest that on-table extubation after pediatric cardiac surgery is feasible and in our cohort was associated with a favorable postoperative course. Full article