# Cardiothoracic Transplant Surgery and Enhanced Recovery: Recent Advances and Perspectives

## TL;DR

This paper reviews how Enhanced Recovery After Surgery (ERAS) protocols can improve outcomes for patients undergoing cardiothoracic transplant surgery.

## Contribution

The paper evaluates recent ERAS advancements specifically tailored for cardiac and thoracic transplant patients.

## Key findings

- ERAS protocols can reduce complications and shorten hospital stays in cardiothoracic transplant patients.
- Preoperative prehabilitation, minimally invasive techniques, and opioid-sparing pain management are key ERAS strategies.
- The paper identifies research gaps and suggests standardizing ERAS for better outcomes in this high-risk population.

## Abstract

Introduction: Cardiothoracic transplant surgery represents a critical intervention for patients with end-stage heart and/or lung failure. While advancements in surgical techniques and perioperative management have enhanced survival rates, these procedures remain associated with significant morbidity, extended hospitalizations, and complex recovery trajectories. Background/Objectives: Enhanced Recovery After Surgery (ERAS) protocols, originally developed for colorectal surgery, have shown promise in optimizing perioperative care across various surgical disciplines. However, their application in cardiac and thoracic transplantation is still emerging. This article evaluates recent advancements in ERAS protocols tailored to cardiac and thoracic transplant patients, focusing on preoperative, intraoperative, and postoperative interventions. Results: Evidence highlights the potential of ERAS to reduce complications, shorten hospital stays, and improve long-term outcomes. Key strategies include preoperative optimization through nutritional and psychosocial prehabilitation, intraoperative adoption of minimally invasive techniques and refined anesthesia practices, and postoperative protocols emphasizing opioid-sparing pain management, early mobilization, and nutritional recovery. Conclusions: This review identifies gaps in current research and offers recommendations for the broader implementation and standardization of ERAS protocols in cardiothoracic surgery, with emphasis on cardiothoracic transplantation, aiming to improve outcomes for this high-risk population.