Cor Vasa 2015, 57(2):e91-e94 | DOI: 10.1016/j.crvasa.2015.03.001

Value of autopsy in cardiac surgery

Petr Němec^*, Petr Fila, Jan Štěrba, Jiří Černošek

Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Introduction: With improvements in preoperative diagnostics and postoperative care the value of autopsy has been questioned. The aim of our study was to prospectively assess the current value of autopsy in patients after cardiac surgery.

Methods: Between January 2007 and December 2013 there were 7 800 patients operated on for heart disease. Two hundred and thirteen of them died postoperatively, resulting in an overall in-hospital mortality of 2.7%. Autopsy was performed on 158 patients (74%). Data regarding the cause of death from clinical and autopsy findings were analysed and compared.

Results: Artificial ventilation, inotropic support before operation, NYHA class IV, and renal failure were the most common preoperative risk factors and surgery for postinfarction ventricular septal defect, emergency operation, operation for acute dissection, triple valve surgery and the necessity for circulatory arrest were the most significant operative risk factors. The most frequent cause of death was cardiac failure or a sepsis and/or multiorgan failure. Missed major diagnosis (class I and II) was found in 21 patients (13.3%) and missed minor diagnosis was found in 17 patients (10.4%). Of the seven patients with class I error, six died due to unidentified abdominal complications.

Conclusion: Autopsy remains the most specific indicator of errors in diagnostics and surgery in patients with cardiac disease. It is a valuable tool for quality assessment and may contribute to the improvement of patient healthcare. Clinicians should pay special attention to abdominal symptomatology in patients after cardiac surgery because this was the main cause of diagnostic errors.

Keywords: Autopsy; Cardiac surgery; Cause of death; Risk factors

Received: February 23, 2015; Accepted: March 1, 2015; Published: April 1, 2015  Show citation