[Operative risk factors and polyvalvular cardiac surgery].
The aim of this study was to identify risk factors for morbidity and mortality in cardiac valvular surgery. Two hundred and fifty-four patients underwent polyvalvular surgery between May 1996 and December 1998. The mean age was 36.8 years (range 4-66 years) and the group comprised 148 women. Two subgroups were defined: the first (184 patients), characterised by associated mitral and tricuspid valve disease: the second (70 patients), characterised by associated mitral and aortic valve disease with a tricuspid lesion in about half the cases. The risk factors of morbidity and mortality analysed were: Clinical: previous history of cardiac failure, NYHA classification, atrial fibrillation and cardiothoracic index. Doppler echocardiographic: left ventricular end systolic dimension > 50 mm, left ventricular and diastolic dimension > 70 mm, fractional shortening < 28%, ejection fraction < 40%: systolic pulmonary artery pressure > 30 mmHg. Haemodynamic: capillary wedge pressure > 20 mmHg, systolic pulmonary artery pressure > 30 mmHg. The authors identified three statistically significant risk factors for operative morbidity and mortality in polyvalvular cardiac surgery: Previous history of one or more episodes of cardiac failure NYHA functional Classes III or IV fractional shortening < 28%. The morbidity and mortality were lower when patients were operated before these poor prognostic factors were observed.
Service de chirurgie cardiovasculaire.
M E
ME
Nouar
K
K
Lounes
H
H
Laouer
F Z
FZ
Barrache
M
M
Djenas
R
R
Mehyaoui
A
A
Zerhouni
M O
MO
Amrane
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D011183:Postoperative Complications; D012307:Risk Factors; D016277:Ventricular Function, Left