Cor Vasa 2006, 48(3):85-88 | DOI: 10.33678/cor.2006.033

Clinical outcome versus post-mortem finding in cardiac surgery

Petr Němec^1,*, Vilém Bruk¹, Roman Hájek¹, Patrik Flodr²

¹ Kardiochirurgická klinika Fakultní nemocnice Olomouc

² Ústav patologie Lékařské fakulty Univerzity Palackého, Olomouc, Česká republika

Introduction:
The clinical diagnosis of death may be inaccurate after cardiac surgery. Autopsy is an important source of knowledge and an integral part of medical education. The only true results can be obtained by comparing the two procedures.

Methods:
Data of all in-hospital deaths after cardiac surgery, occurring in a single institution between February 2002 and December 2004, were collected prospectively. Clinical diagnoses were compared with the autopsy findings.

Results:
Between February 2002 and December 2004, a total of 2,613 patients were operated on. During this period, 69 deaths occurred. Autopsy was performed in 63 patients (91.3%). The mean age of patients at death was 72.0 ± 8.2 years, 62% were male, 44.9% had diabetes, 63.8% had a history of myocardial infarction. Mean ejection fraction was 38.4 ± 13.9% and mean functional class was 3.3 ± 0.9. The most common procedure was coronary artery bypass grafting alone in 47.8% patients, and together with other procedures in 36.2%. Valve surgery was performed in 5.8% and other procedures in 10.1%. The mean time to death was 12.3 ± 16.5 days (range 0-65 days). The most frequent cause of death was heart failure (in 47.6%). Multiorgan failure was the cause of death in 41.3%. Post-mortem examination revealed another or unsuspected cause of death in 8 patients (12.7%). Three out of 8 patients died due to gastrointestinal disease. Additional findings not revealed during life were disclosed in another 6 patients, in whom the clinical and autopsy causes of death were in agreement.

Conclusions:
Autopsy may identify an undiagnosed cause of death in a considerable proportion of patients following cardiac surgery. Moreover, some additional or overlooked findings may contribute to the final picture of clinical failure.
Post-mortem information remains the gold standard and is a most important tool for improving clinical practice.

Keywords: Cardiac surgery; Autopsy; Cause of death

Published: March 1, 2006  Show citation