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Cardiologie pp 473-482 | Cite as

52 Hart en niet-cardiale chirurgie

  • D. Poldermans
Chapter
Part of the Quintessens book series (QUI)

Samenvatting

Cardiale complicaties zijn de belangrijkste oorzaak van perioperatieve morbiditeit en mortaliteit. In Nederland worden jaarlijks 1,5 miljoen operaties verricht, waarbij in de perioperatieve periode 15.000 (1%) patiënten overlijden, van wie ongeveer 3000 (0,3%) aan cardiovasculaire complicaties. De incidentie van perioperatieve cardiale complicaties is vergelijkbaar met die in de Verenigde Staten van Amerika, waar jaarlijks 26 miljoen ingrepen worden verricht en 78.000 (0,3%) fatale cardiovasculaire complicaties optreden. In de eerste dertig dagen na de operatie kan het risico op cardiale dood, myocardinfarct of hartfalen oplopen tot 10%, afhankelijk van het type operatie en de aanwezigheid van onderliggend coronairlijden. Het is van belang bij de preoperatieve cardiale beoordeling de langetermijnprognose van de onderliggende comorbiditeit, zoals linkerventrikelfunctie, coronairlijden en kleplijden, in de beoordeling mee te nemen. Zo bedraagt de mortaliteit van patiënten die succesvol geopereerd zijn wegens claudicatio intermittens in de eerste drie jaar na de operatie 30-40%. Dit berust op het frequent voorkomen van onderliggend coronairlijden, oplopend tot 70%, waarbij de langetermijnoverleving was gecorreleerd aan de aanwezigheid en de ernst van coronairlijden. Deze patiënten zijn vaak asymptomatisch vanwege een gebrekkig inspanningsvermogen, maar de klachten kunnen na de geslaagde operatie manifest worden. De arts die patiënten vóór een operatie onderzoekt, heeft derhalve een belangrijke taak om het cardiale risicoprofiel in kaart te brengen en eventueel in positieve zin te beïnvloeden, niet alleen om de perioperatieve prognose maar ook de prognose op lange termijn te verbeteren.

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Copyright information

© Bohn Stafleu van Loghum, Houten 2008

Authors and Affiliations

  • D. Poldermans
    • 1
  1. 1.Erasmus Medisch CentrumRotterdam

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