ACCELERATED RECOVERY AFTER CORONARY-ARTERY BYPASS-SURGERY IN PATIENTSWITH POOR LEFT-VENTRICULAR FUNCTION - PRELIMINARY-REPORT

The success of ''fast-track'' accelerated recovery pathways in improvi ng patient outcomes after coronary artery bypass graft surgery (CABG) has prompted expanded application. Although initially used only in rou tine cases, higher-risk cohorts may also benefit from this collection of management techniques. Twenty-seven consecutive patients with eject ion fractions (EFs) less than or equal to 30 per cent (group I) underg oing CABG requiring cardiopulmonary bypass were started on our routine care path. The results of this effort were retrospectively compared w ith 27 concurrent patients with an EF greater than or equal to 50 per cent (group II) undergoing CABG at our institution. Outcome criteria i ncluded postoperative extubation (by 6 hours), transfer from intensive care unit (in less than or equal to 24 hours), and hospital discharge on or before postoperative day 5. As anticipated, group I patients de viated from pathway criteria more frequently than did group II. Howeve r, despite severely compromised preoperative cardiac function, 52 per cent of group I patients were extubated within the first 6 hours posto peratively, 51 per cent were discharged from the intensive care unit o n the Ist postoperative day, and 52 per cent were discharged from the hospital within the first 5 postoperative days. Group II patients' val ues for these parameters were 96, 96, and 70 per cent, respectively. N o adverse effects could be attributed to pathway expectations. The res ults of this preliminary study suggest that accelerated care pathways may be safely applied to patients with severely low EFs and deserve fu rther study.