ERAS Including Minimal Narcotic Pain Management is Successful After Heart Transplant and LVAD Implantation: A Single Center Review

Abstract

Objective: To assess the outcomes of an enhanced recovery after surgery (ERAS) protocol for heart failure patients receiving heart transplant or left ventricular assist device (LVAD) surgery.

Methods: A single center, retrospective IRB study reviewed consecutive heart transplant and LVAD implantation patients from May 2020 to May 2022. Patients received an organized ERAS protocol. The following data points were evaluated: demographics, medication history, date of surgery, acute medication use, nutrition and bowel function assessment, time to liberate from mechanical ventilation, delirium screening, pain scores, functional status, time from implant to hospital discharge, and pain medications at both discharge and 30-day follow-up.

Results: Thirty-two patients received ERAS: 18 heart transplants and 14 LVAD implants. One heart transplant was excluded from ERAS protocol due to delayed sternal closure for 72 hours after surgery. For a seven-day postoperative observation period, three patients (9%) had a positive delirium score. Pain scores were acceptable. The mean morphine milligram equivalent (MME) was 26.25 mg per day. No patient developed gastrointestinal complications. The average length of stay after surgery was 25 days for heart transplant, and 19 days for LVAD implant. No patients were prescribed opioids at discharge, and no patients reported opioid use over baseline at 30-days.

Conclusion: For heart transplant and LVAD surgery, ERAS reduced opioid consumption, preserved mechanical ventilation time, and limited acute delirium. ERAS limited postoperative opioid induced gastroparesis while preserving acceptable pain scores, maintained the length of hospitalization, and prevented unnecessary opioid prescribing at discharge up to and including 30 days thereafter.