Glasz Tibor, Frenken Michael, Knieriem Hans-Jürgen, Krian Arno
2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Ulloi út 93, 1091 Budapest, Hungary.
Virchows Arch. 2003 Oct;443(4):528-35. doi: 10.1007/s00428-003-0848-5. Epub 2003 Jul 29.
A retrospective cardiopathological and clinical study was conducted in order to determine causes of perioperative death following coronary artery bypass grafting (CABG).
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.
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.
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%).
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.
开展一项回顾性心脏病理学和临床研究，以确定冠状动脉旁路移植术（CABG）围手术期死亡的原因。
1992年1月至1995年6月期间，德国杜伊斯堡心脏中心共进行了5749例CABG手术。术后，218例患者在医院死亡（死亡率3.8%）。58例在杜伊斯堡贝塞斯达医院病理研究所进行了尸检，其中32例尸检病例适合我们的研究。选择的依据是临床和形态学数据的可获取性以及术后30天内死亡。
对每例病例进行心脏形态学分析，并评估手术和临床数据，以便得出死亡机制的结论。
根据我们定义的标准，确定了以下死亡原因：（1）手术并发症（43%）；（2）严重冠状动脉疾病且血运重建不完全（41%）；（3）充血性心力衰竭（13%）；（4）非心脏并发症（3%）。
本研究中定义的标准可能有助于评估心脏直视手术后的死亡原因，并有助于比较未来系列研究的结果。确定死亡原因对于心脏外科医生重新考虑手术指征和手术质量很重要。
