Notre étude est une étude rétrospective monocentrique avec les biais que ce type d’étude comporte. Du fait de l’incidence faible de cette pathologie dans le cadre de la
chirurgie cardiaque, le nombre de patients cas est limité surtout, si l’étude est réalisée dans un seul centre.
! #&! Les examens complémentaires (coloscopie et scanner abdominal) n’ont pas été réalisés de façon systématique. On n’a donc pas pu comparer exactement l’apport d’un examen par rapport à l’autre, car l’indication de celui ci était multifactorielle, aboutissant d’une discussion multidisciplinaire, de l’état clinique du patient et d’une orientation clinique.
Conclusion
Notre étude a permis d’établir un score diagnostique d’ischémie digestive chez les patients en postopératoire de chirurgie cardiaque. Ce test fait appel à quatre variables biologiques
(ASAT, Lactates, PCT, Myoglobine) dosables en routine. Il permet de faire le diagnostic avec une sensibilité de 85% et une spécificité de 95%. L’utilisation de ce test pourrait permettre d’accélérer la prise en charge thérapeutique de ces patients et ainsi diminuer la mortalité liée à cette pathologie. En plus, l’application de ce score pourrait être étendue à d’autres types d’ischémie digestive et en dehors de la période post opératoire de chirurgie cardiaque. Dès la moindre suspicion clinique, l’utilisation de score prédictif d’ischémie digestive devrait déclencher une cascade d’examens complémentaires et d’attitude chirurgicale invasives, ou d’autres thérapeutiques comme l’angiographie et injection de prostaglandine, pour permettre de proposer aux patients un traitement permettant d’espérer une diminution du taux de mortalité effroyable.
Enfin, afin d’évaluer la performance de ce test, et de vérifier si ce dernier peut être exploitable pour les autres types d’ischémie digestive en dehors de la chirurgie cardiaque, il conviendrait de réaliser une étude prospective sur une grande série de patients et d’y inclure l’exhaustivité des cas d’ischémie digestive, idéalement de manière multicentrique.
! #'!
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ISCHEMIE DIGESTIVE EN POST OPERATOIRE DE CHIRURGIE CARDIAQUE :