[Surgery in patients with previous heart surgery. Apropos of 21 patients]

Authors relate 22 non cardiac operations among 21 patients having previously undergone cardiac surgery. Oral anticoagulant therapy was discontinued before non cardiac operation while subcutaneous heparine therapy was initiated. There were no bleeding or thromboembolic complications during the perioperative period or later in the follow-up. In order to prevent bacterial endocarditis, prophylactic antibiotherapy was associated with careful surgical asepsis. No case of endocarditis was encountered during a mean follow-up of 22 months. Cardiac medications such as digitalis and beta adrenergic blockers were maintained as long as possible during the perioperative period while their dosage and clinical effects were closely monitored. No patient did present cardiac failure, significant arrhythmia or blood pressure impairment. No perioperative myocardial infarcts occurred in the group of coronary artery bypass graft patients. Those patients were managed in order to maintain their myocardial muscle work in optimal ranges thanks to selective premedication, brief interruption of beta adrenergic blockers, strict control of fluid balance and careful postoperative pain relief.