Vol. 20 JA2016 - cardiac

C-14 – Deleterious effects of loss of independence assessed with the Katz Index after aortic valve replacement in elderly patient

Nicolas d’Ostrevy, Hung Ngo Thanh, Céline Lambert, Frédéric Martins-Condé, Gildas Coutu, Bruno Lesourd, Bruno Pereira, Kasra Azarnoush, Lionel Camilleri Institution : Service de chirurgie cardiovasculaire, CHU Gabriel-Montpied, Clermont-Ferrand Objectives : The aim of this study was to distinguish among elderly patients those whose postoperative evolution further to surgical aortic valve replacement was unsatisfactory and to seek for geriatric tests predictive of this evolution. Methods : We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement. Results : In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P=0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P=0.03) and a Katz index ≤5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48% [IQR 39-57]. The Katz index ≤5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P=0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001). Conclusion : In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.
novembre 29, 2016
Chirurgie cardiaque · Vol. 20 Abstract 2016

C-46 – Facteurs de risque de confusion en chirurgie cardiaque

Alexandra Stoyanov, Jean-Jacques Corbeau, Thomas Reydel, Alexis Donzeau, Simon Dang Van, Jean-Louis de Brux, Christophe Baufreton Service d’anesthésie réanimation en chirurgie cardiaque, CHU d’Angers     Objectif La confusion postopératoire est une complication classique en chirurgie cardiaque. Nous avons recherché sa fréquence de survenue et les facteurs de risque (FDR) pré et peropératoires.   Méthode étude rétrospective analytique observationnelle monocentrique du 1er janvier 1997 au 31 décembre 2011 sur les opérés en chirurgie cardiaque suivis en réanimation.   Résultat 7190 patients ont été inclus. Avant 2002, le taux de confusion était de 16,7 versus 12,5 après. Dans notre modèle d’analyse multivariée, issu de l’analyse univariée, sont retenus comme FDR : âge, OR par année = 1,07 [1,06-1,08] maladie de Parkinson, OR  = 2,3 [1,3-4,3] traitement neuroleptique, OR = 2,25 [1,5-3,4] traitement antidépresseur, OR = 1,8 [1,3-2,5] benzodiazépine, OR = 1,5 [1,2-1.7] intervention en urgence, OR = 1,9 [1,4-2,5] AVC, OR = 1,6 [1,3-2,0] diabète insulinodépendant, OR = 1,5 [1,2-2,0] insuffisance rénale, OR par ml de clairance = 0,994 [0,991-0,996] transfusion homologue, OR = 1,3 [1,1-1,5] artériopathie extracardiaque, OR = 1,2 [1,01-1,5] chirurgie sans CEC, OR = 0,49 [0,28-0,85]   Conclusion Le modèle de CEC que nous utilisons à Angers depuis 2002 avec contrôle des aspirations chirurgicales (Cell Saver), traitement de surface du circuit qui est clos, normothermie stricte, réduction des doses d’héparine et monitorage des gaz du sang, permet de limiter le risque de confusion.     Risk factors for postoperative confusion in cardiac surgery   Objectives Postoperative confusion is a common complication in cardiac surgery. We investigated the frequency of occurrence and risk factors (FDR) pre- and intraoperative.   Methods Analytical observational single-center retrospective study from 1 January 1997 to 31 December 2011 on the operated heart surgery followed by resuscitation.   Results 7190 patients were included. Prior to 2002, the rate of confusion was 16.7 versus 12.5 after. In our multivariate model, derived from the univariate analysis, were selected as FDR: Age, OR=1.07 per year [1.06 to 1.08] Parkinson’s disease, OR=2.3 [1.3 to 4.3] Neuroleptic therapy, OR=2.25 [1.5 to 3.4] Antidepressants, OR=1.8 [1.3-2.5] Benzodiazepine, OR=1.5 [1,2-1.7] Emergency intervention, OR=1.9 [1.4-2.5] AVC, OR=1.6 [1.3-2.0] Insulin dependent diabetes, OR=1.5 [1.2-2.0] Renal clearance, OR per ml=0.994 [0.991 to 0.996] Homologous transfusion, OR=1.3 [1.1-1.5] Extracardiac arterial, OR=1.2 [1.01 to 1.5] Surgery without CPB, OR=0.49 [0.28 to 0.85]   Conclusion The model of CEC we use in Angers since 2002 with controlled surgical aspirations (Cell Saver), surface treatment of the circuit is closed, strict normothermia, reduced doses of heparin and blood gas monitoring, allows limit the risk of confusion.    
juin 10, 2016