Drainology Roundtable at EACTS
The annual Medela ERAS, MICS & Drainology Roundtable, held during the EACTS 2025 meeting in Copenhagen and chaired by Prof. Dr. Jolanda Kluin and Prof. Dr. Evaldas Girdauskas, brought together leading cardiac surgery experts to explore the latest advances in perioperative optimization, minimally invasive techniques, and postoperative recovery pathways. The program addressed key challenges in enhancing recovery after cardiac surgery, combining evidence-based insights with interdisciplinary strategies to improve patient outcomes and reduces complications.
Together, these sessions underscored the transformative potential of a multidisciplinary approach that integrates surgical innovation, perioperative anesthesia, ICU protocols, and early mobilization. The discussions reflected a shared commitment to advancing patient-centered care and improving long-term quality of life after cardiac surgery.
Barriers to POD 1 Discharge after Cardiac Surgery
Prof. Dr. Wouter Oosterlinck, University Hospital Leuven, Belgium
Prof. Oosterlinck highlighted a paradigm shift toward ultra-early discharge (often on postoperative day 1) after cardiac surgery, driven by Enhanced Recovery After Cardiac Surgery (ERACS) protocols. This approach combines minimally invasive techniques, early extubation, optimized pain and fluid management, and rapid mobilization, supported by multidisciplinary coordination and digital tools like the moveUP platform for continuous patient monitoring. While clinical challenges such as bleeding, pain, and atrial fibrillation remain, prehabilitation, patient education, and structured follow-up are key enablers. Early discharge improves resource efficiency, patient satisfaction, and hospital economics, signaling a future where safe, accelerated recovery becomes standard practice.
Risk Factors and Prevention of Delirium after Cardiac Surgery
Prof Dr. Hassina Baraki, University Hospital Basel, Switzerland
Dr. Baraki highlighted postoperative delirium as a serious yet often overlooked complication in cardiac surgery, affecting up to one-third of patients and linked to increased mortality, prolonged hospitalization, and long-term cognitive decline. New guidelines recommend systematic screening for five days post-surgery using tools like CAM-ICU and 4AT. While non-modifiable risks include age and comorbidities, modifiable factors (such as frailty, malnutrition, and sensory deficits) can be addressed through prehabilitation and optimized perioperative care. Findings from the FINDERI Study confirm delirium’s strong association with surgical complexity and long-term neurological impact. Prevention focuses on non-pharmacological strategies: early mobilization, reorientation, sensory support, and family involvement, alongside tailored rehabilitation and psycho-cardiology integration. Structured follow-up and risk-adapted protocols are essential to reduce incidence and protect cognitive outcomes in vulnerable patients.
POAF and Beyond
Dr. Ziyad Gunga, Lausanne University Hospital (CHUV), Switzerland
Dr. Gunga addressed postoperative atrial fibrillation (POAF), a common complication affecting 15–30% of cardiac surgery patients, now defined by the 2024 ESC guidelines as any onset of AF after surgery. POAF significantly increases risks of stroke, renal failure, prolonged hospitalization, and mortality, with retained blood syndrome (RBS) identified as a key inflammatory trigger. Lausanne’s ERAS-based four-pillar strategy (posterior pericardial drain placement, posterior pericardiotomy, optimized chest drainage using digital systems, and preventive medication) has reduced POAF incidence from 39% to 20%. These evidence-based interventions highlight the importance of early blood evacuation, inflammation control, and standardized protocols to improve outcomes and resource efficiency in cardiac surgery.
MICS and Drainology – A Synergistic Approach
Prof. Dr. Torsten Doenst, University Heart Center Thüringen, Germany
Prof. Doenst shared a case illustrating that successful cardiac surgery depends on more than incision size; it requires precision and a coordinated care ecosystem. Minimally invasive techniques must uphold the same standards as sternotomy, as shown by data from the Mini-Mitral Registry. Beyond surgery, factors like patient condition, perioperative management, and even environmental details influence recovery. Prof. Doenst emphasized “Drainology,” the science of chest drainage, noting that modern digital systems improve comfort, reduce noise, and support early mobilization. He concluded that excellence in cardiac care lies in integrating surgical mastery with interdisciplinary teamwork, meticulous postoperative practices, and patient-centered details that optimize healing and quality of life.