title: [Preoperative assessment in emergency cardiovascular surgery].
abstract: In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abdominal aortic aneurysm repair accounted for 30% and 20% respectively and the corresponding proportion for peripheral vascular surgery is 19%. However, emergency surgery for acute coronary ischemia, valvular and congenital heart disease accounted for somewhat less than 10% for each group of these pathologies. Systematic pre-operative diagnostic work-up is a recognized tool for procedure related risk assessment and superior management of diseases. However, hemodynamic instability and other time related events correlated with negative outcome, are the main driving forces for accelerated diagnostic pathways
authors.affiliation: Service de chirurgie cardio-vasculaire, CHUV, Lausanne. ludiwg.von-segesser@chuv.hospvd.ch
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: von Segesser
authors.forename: Pierre-Guy
authors.initials: PG
authors.lastname: Chassot
authors.forename: Antonio
authors.initials: A
authors.lastname: Corno
authors.forename: Markus
authors.initials: M
authors.lastname: Bernath
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.forename: Bettina
authors.initials: B
authors.lastname: Marty
authors.forename: Patrick
authors.initials: P
authors.lastname: Ruchat
authors.forename: Philippe
authors.initials: P
authors.lastname: Gersbach
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.forename: Adam
authors.initials: A
authors.lastname: Fischer
authors.forename: Michel
authors.initials: M
authors.lastname: Hurni
authors.forename: Frank
authors.initials: F
authors.lastname: Stumpe
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000601:surgery*; D004638:Emergency Treatment; D006801:Humans; D011300:Preoperative Care; D014463:Ultrasonography
vernacular_title: Bilan préopératoire pour la chirurgie cardio-vasculaire en urgence.