[Cooperative survey of the results of coronary surgery during cardiac rehabilitation]

Abstract

The aim of this study was to assess the type and frequency of cardiac and extracardiac complications of coronary artery surgery in patients referred for cardiac rehabilitation (for which it is one of the principal indications): this was a prospective study carried out simultaneously in 30 cardiac rehabilitation units during December 1992 and including 533 patients (81 women, 452 men) with a mean age of 62.1 years. The total number of coronary grafts was 1,361 (on average 2.5 per patient); the internal mammary artery was used in 87% of cases; revascularisation was complete in 66.4% of patients. One or more complications were observed in 79% of patients during the hospital period (68.9%) and/or during the rehabilitation phase (44.7%), independently of age, sex, duration of cardiopulmonary bypass, or the interval to cardiac rehabilitation. The main extracardiac complications were respiratory (31.5%), disturbances of cerebral function (15.6%) and renal failure (10.3%). Cardiac complications comprised arrhythmias, essentially supraventricular (21.3%), infarction and residual postoperative ischaemia (8.4%), large pericardial effusion (7.5%), cardiac failure (4.5%), and wound infection (4.3% including 2.8% mediastinitis). Anaemia, a secondary effect of cardiopulmonary bypass, was observed in 25% of patients. This prospective study, though affected by a bias of selection and not fully representative of the surgical outcome, shows the need for a personalised management of these patients, the early indication of cardiovascular rehabilitation contributing to the optimisation of coronary artery surgery at less cost and with improved safety.