ERAS in Robotic Cardiac Surgery

Mini invasive cardiac surgery (MICS) procedures leave patients best suited for the enhanced recovery after surgery (ERAS) pathway of care. Robotic MICS has the potential to boost patient outcomes further when combined with ERAS. Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. The benefits of robotic cardiac surgery include reduced need for transfusions; shorter intensive care unit (ICU) and hospital length of stay; lower incidence of atrial fibrillation, acute kidney injury, stroke, and permanent pacemaker (PM) implantation; shorter mechanical ventilation hours; lower readmission rates; lower conversion to open MVR; improved postoperative quality of life; and faster return to work. Integrating ERAS with robotic MICS means adopting ERAS evidence-based core principles: the resulting approach embraces preoperative, intraoperative, and postoperative care. During patient selection, great importance is given at a prehabilitation program that includes a well-tailored patient blood management strategy. The intraoperative management has as a goal a fast-track extubation of the patient at the end of the surgery, in the operating room (OR): this is achieved through a careful one-lung ventilation, a multimodal anesthesia and analgesia, temperature management, and short cardiopulmonary bypass (CBP) times. In the postoperative care, utmost importance is given to physiotherapy.