[Prognostic factors of coronary artery bypass surgery].
During these 10 last years, even though patients had a more and more severe condition, the results of coronary artery bypass surgery have continuously improved. According to Society of Thoracic Surgeons data, the operative risk increased by 1/3 (2.6% in 1990 vs. 3.4% in 1999), whereas the per-operative mortality was reduced by 1/4 (3.9% in 1990 vs. 3% in 1999), and is currently stabilized around 2.5-3%. The incidence of complications is a non-negligible marker. The complications observed are mostly neurological (2%), renal (4%), myocardial (4%), infectious (0.5 to 2%), and respiratory (10%). Their occurrence is related to the presence of preoperative risk factors: age (>60 years), sex (female), EF <50%, diabetes, severe obesity, lung disease, renal failure, recent myocardial infarction, redo and/or emergency surgery... The detection and peri-operative control of these factors permit a reduction of complications incidence and limit the length of stay; a better management of per-operative blood glucose in diabetic patients reduced significantly the morbidity. These factors are used in different scores, such as the Euroscore, which seems to be the best predictor of mortality. Patients stratification according to their risk profile permits to inform the patient and his/her family regarding the operative risk and take peri-operative therapeutic decisions, in order to reduce the morbidity and mortality during coronary artery bypass surgery.
Pavie
A
A
Service de chirurgie cardiovasculaire, institut de cardiologie, hôpital La Pitié-Salpêtrière, 47 bd de l'Hôpital, 75013 Paris. alain.pavie@psl.ap-hop-paris.fr
Doguet
F
F
Bonnet
N
N
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008171:Lung Diseases; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D051437:Renal Insufficiency; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors