The increasing proportion of obese patients candidates for a cardiac surgery obliges us to reflect on the périopératoire risk this population in order to direct with better our assumption of responsibility.

We studied the results of the cardiac surgery for the obese patients presenting an index of body mass (IMC) >40.

Retrospective study on a prospective basis of data of 3564 patients operated in surgery programmed between 2004 and 2012. The population was divided into three groups: I (n=2494): 20 <IMC <29,9; II (n=1014): 30 < IMC < 39,9 and III (n=56): IMC <40. The IMC < 20 were excluded because of a surmortality brought back in the literature. The principal criterion of judgement was mortality at 90 days. An analysis of multivariate regression was carried out in order to identify the prognostic factors of mortality. A comparative study of the principal postoperative complications was carried out.

Mortality at 90 days was 4,1% in group I, 3,7% in group II and of 0% in group III (p NS). In group III, the average age was younger: 57,2±8,2 years vs 68,4±10,7 years (group I) and 64,9±9,8 (group II) (p<0,05). 58, 2% and 27,7% of the patients had respectively a coronary or valvular surgery isolated, 9,7% a valvular and coronary combined surgery and 4,4% a different gesture. The rates of parietal surgical recoveries or médiastinites were comparable (group I: 2,6% N = 64; group II: 5,3% N = 54; group III: 5,4% N=3) (p NS). In multivariate analysis, the factors influencing mortality were the age > 60 years and the transfusion of globular bases. The BMI > 40 did not influence mortality.

Programmed cardiac surgery carried out among patients presenting one IMC > 40 does not seem to be accompanied by an increase by mortality and morbidity périopératoire. This population was younger in our experiment, probably minimizing the postoperative rate of complications. Despite everything, the IMC taken separately should not be a criterion of surgical counter-indication.