Fast track protocol improves outcomes for patients after minimally invasive valve surgery

Calgary’s minimally invasive cardiac surgery team is improving outcomes for patients. Traditionally, cardiac operations, such as valve repair or replacement, were only possible through open-heart surgery, and the recovery time is long, as it takes six weeks for the patient’s sternum to heal after the procedure.

Minimally invasive surgery, on the other hand, involves a small incision on the patient’s side between the ribs. These techniques result in less blood loss, less pain following the procedure, and patients ultimately go home about two days earlier and back to their regular lives sooner.

Calgary’s minimally invasive team implemented a fast-track protocol for minimally invasive mitral surgery in September 2022.

Designed by a group that includes surgeons, physicians, nurses, physiotherapists, and other allied health professionals within the Libin Cardiovascular Institute, the fast-track protocol streamlines the process following surgery. Tubes, lines and drains are removed sooner, pain medications are reduced sooner and patients are encouraged to get up and move around on the day of their surgery.

Fifth year cardiac surgery resident Dr. Amy Brown, MD, presented the results of implementing the new protocol at this year’s Canadian Minimally Invasive Cardiac Surgery Meeting, held in Calgary from Nov. 3-4, 2023, as part of the conference’s inaugural resident research competition.

“My study compares patients who have gone through the fast-track protocol with those who didn’t,” says Brown, who earned her MD at Dalhousie University. “We are finding the protocol is working. Patients are getting out of the intensive care unit faster, going home sooner, and hospital readmission rates have decreased.”

The cardiac surgery program in Calgary has been a leader in improving patient experience for several years. The Enhancing Recovery After Surgery (ERAS) program was introduced in 2021. Led by a team of multidisciplinary researcher-clinicians within the Institute, including cardiac anesthesiologist Dr. Alex Gregory, MD, the program works to ensure optimal patient experience from pre- to post-surgery care. 

Brown, who, in addition to her cardiac surgery residency is pursuing a masters in Public Health through Harvard, says the fast-track protocol takes ERAS to the next level by tweaking postoperative care even further.  

“We are unique in Calgary with our post cardiac surgery protocols,” says Brown. “It’s great, because patients can go home sooner with less burden on the healthcare system.”

Brown is hoping to complete her surgical residency within the next two years. Her goal is to combine a clinical practice in cardiac surgery with research.

“Clinical research helps improve patient experience in a different way outside of the operating room,” she says. “Research allows us to really advance innovation and make sure the patient experience is as good as possible.”