Mechanisms of death in the early postoperative period following coronary artery bypass grafting for acquired heart disease. A clinicopathological study of 32 cases.

OBJECTIVES

A retrospective cardiopathological and clinical study was conducted in order to determine causes of perioperative death following coronary artery bypass grafting (CABG).

EXPERIMENTAL DESIGN

Between January 1992 and June 1995, a total of 5749 CABG procedures were performed at the Heart Center Duisburg (Germany). Following the procedures, 218 patients died in hospital (mortality rate 3.8%). Fifty-eight were autopsied at the Institute of Pathology, Bethesda Hospital, Duisburg, and 32 autopsied cases were amenable to our study. Basis for selection was accessibility of clinical and morphological data and a postoperative death within 30 days.

METHODS

In each case, morphological analysis of the heart and an evaluation of surgical and clinical data were performed in order to draw a conclusion on the mechanism of death.

RESULTS

Using criteria defined by us, the following causes of death were determined: (1) surgical complications (43%); (2) severe coronary artery disease with incomplete revascularization (41%); (3) congestive heart failure (13%); (4) non-cardiac complications (3%).

CONCLUSION

Criteria defined in this study may be useful in evaluations of causes of death after open heart surgery and may help to compare results in future series. Determination of the cause of death is important for the cardiac surgeon to reconsider indications and quality of surgical procedure.