Enhanced recovery after cardiac surgery implementation enables rapid postoperative recovery with excellent safety: results from an initial minimally invasive cohort

Background The Enhanced Recovery After Surgery (ERAS) pathways have been developed to optimize perioperative care and accelerate recovery. However, structured implementation in cardiac surgery remains limited. The present study evaluated the feasibility, adherence, and early perioperative outcomes of an ERAS program during its implementation phase. Methods The present prospective observational study included the initial n = 30 consecutive patients who underwent minimally invasive cardiac surgery during the period from September to December of 2025. The surgical interventions included fully endoscopic mitral valve replacement in combination with concomitant procedures (n = 25) and minimally invasive direct coronary artery bypass (n = 5). The ERAS protocol incorporated standardized perioperative care, encompassing patient education, opioid-sparing multimodal analgesia with routine PECS I/II blocks, early extubation, mobilization, and enteral nutrition. The observed adherence to established protocols was 100%, and the procedure was technically successful in all cases. Results The median age of the cohort was found to be 61 years (35–79 years), with a EuroSCORE II of 1.7 (0.7–4.2). The recovery metrics exhibited a swift rehabilitation process, with ventilation requiring an average of 5 (2–24) hours, mobilization requiring an average of 8 (4–26) hours, and oral nutrition requiring an average of 9 (4–26) hours postoperatively. The transition to the normal ward occurred after an average of 1 (1–5) days, and the removal of drainage tubes took an average of 1 (1–3) days. The median pain score was 2 (0–4), and the hospital stay was 5 (3–11) days. The absence of delirium, MACCE, infections, and in-hospital mortality (all 0%) is indicative of a successful clinical outcome. New-onset atrial fibrillation occurred in 3.3% of the patients, and 60-day rehospitalization occurred in 10% of the patients. Conclusion In this preliminary implementation cohort, the use of ERAS with opioid-sparing regional anaesthesia was found to be feasible, with full adherence, rapid recovery, and excellent safety, thereby supporting broader integration into perioperative cardiac care.