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Preoperative care.

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Preoperative care.

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Identification of preoperative risk factors influencing survival and survival free from mitral reoperation, in surgery for ischemic and functional mitral regurgitation.Method: This is a retrospective study on 233 patients (mean age 67 .9 ± 10.2 years) who underwent, between 1998 and 2010, a mitral surgery in context of functional or ischemic mitral regurgitation. 192 patients (82.4%) underwent a mitral surgery associated with CABG and 41 (17.6%) underwent a mitral valve surgery only. Preoperatively, 108 (46.4%) patients had CCS angina class Ill-IV, 115(49.4%) had NYHA Ill-IV, 19 (8.1%) were in cardiogenic shock, 18 (7.7%) had PAH and average ejection fraction was 40.5% ± 14.7%. The average follow-up is 69.6 months and is 82.12% complete.Results: The operative mortality was 13.7% (n = 32). Kaplan-Meier survival at 1, 5 and 10 years were respectively 86.3% ± 5.1%, 71.8% ± 6.8% and 47.7% ± 8.8%. Kaplan-Meier survival free from reoperation at 1, 5 and 10 years were respective ly 95.3% ± 2.6%,91.0% ± 4.7% and 90.9% ± 4.7%. Multivariate analysis (Cox model) showed several independent predictors of survival: age (p <.001), smoking (p <.001), renal failure (p = .001), left-ventricular ejection fraction (p = .041), LVESD 2:55mm(p = .023), cardiogenic shock (p = .048), replacement (vs. repair) (p = .003) and taking statins (protective raie) (p = .026).Conclusion: Surgery for ischemic and functional mitral regurgitation gives good results for survival rates and survival rates without mitral reoperation. The study was able to identify many factors that influence long-term survival and long-term survival without mitral reoperation. Mise en évidence des facteurs de risque préopératoires influençant la survie et la survie libre de réopération dans la chirurgie de l'insuffisance mitrale ischémique et fonctionnelle. Méthode : Il s'agit d'une étude rétrospective sur 233 patients (âge moyen 67.9 ± 10.2 ans) opérés entre 1998 et 2010 d'une chirurgie mitrale dans le cadre d'une insuffisance mitrale fonctionnelle ou ischémique. 192 patients (82.4%) ont subi une chirurgie mitrale associée à un CABG et 41 (17.6%) ont subi une chirurgie mitrale seule. En préopératoire, 108 (46.4%) patients avaient un statut angineux. Ces Ill-IV, 115 (49.4%) avaient un NYHA Ill-IV, 19 (8.1%) étaient en choc cardiogénique, 18 (7.7%) avaient une HTAP et la fraction d'éjection moyenne était de 40,5% ± 14,7%. Le follow-up moyen est 69.6 mois et est complet à 82.12%.Résultats : La mortalité opératoire est de 13.3% (n=31). Les taux de survie observés sur base des courbes de Kaplan-Meier à 1, 5 et 10 ans étaient respectivement de 86.3% ±5.1%, 71.8% ±6.8% et 47.7% ±8.8%. Les taux de survie sans réopération mitrale sur base des courbes de Kaplan-Meier observés à 1, 5 et 10 ans étaient respectivement de 95.3% ±2.6%, 91.0% ±4.7% et 90.9% ±4.7%. L'analyse multivariée (modèle de Cox) a permis de mettre en évidence de manière indépendante les facteurs de risque suivants : âge (p<.001),tabagisme (p<.001), insuffisance rénale (p=.001), fraction d'éjection du ventricule gauche (p=.041), LVESD 55mm (p=.023), choc cardiogénique (p=.048), remplacement (vs. réparation)(p=.003) et la prise de statines (rôle protecteur) (p =.026).Conclusion : la chirurgie des insuffisances mitrales ischémiques et fonctionnelles donne dP bons résultats quant aux taux de survie et aux taux de survie sans réopération mitrale. L'étude a pu mettre en évidence de nombreux facteurs qui influencent la survie à long terme et la survie sans réopération mitrale à long terme .

Preoperative Care --- Mitral Valve Insufficiency

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Part of the popular Core Topics series, this book provides a practical guide to pre-operative assessment for consultants and trainee anaesthetists. Chapters cover comprehensive evidence-based guidance for assessing and managing patients with particular conditions, as well as perioperative risk stratification and challenges of pre-assessment. The chapters have been written by specialists in the respective clinical fields, while all content has been edited by anaesthetists to assure it is relevant and accessible to the anaesthetist in the everyday pre-operative clinic. Written specifically for anaesthetists, this resource will allow every reader to contribute effectively in a multidisciplinary approach when assessing and risk stratifying patients to ensure that they are optimised before surgery.

Anesthesia. --- Surgery, Operative. --- Preoperative care.

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Preoperative Care. --- Postoperative Care. --- Surgical Procedures, Operative.