Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Janne P. Karhunen Pekka J. Karhunen Peter M. Raivio Eero I. T. Sihvo Tiina L. S. Vainikka Ulla-Stina Salminen
- چاپ و سال / کشور: 2009
Description
Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1–3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and their demonstration at autopsy is a challenging task. Isolated CABG was performed in 8,807 patients during 1988–1999.Of the patients, 76 (0.9%) developed sudden postoperative hemodynamic collapse resulting in subsequent emergency reopening of the median sternotomy and open cardiac massage. Further emergency reoperation could be performed in 62 (82%) whereas 14 patients died prior to reoperation and a further 21 did not survive the reoperation or died a few days later. All 35 (46%) patients who did not survive were subjected to medico-legal autopsy combined with postmortem cast angiography. By combining clinical data with autopsy and angiography data, various types of graft complications were observed in 27 (36%, 1.3 per patient) of the 76 patients with hemodynamic collapse. There were no significant differences in the frequency (33 vs. 40%) or number of complicated grafts per patient (1.2 vs. 1.4) between those who survived reoperation and who did not. Autopsy detected 25 major and minor findings not diagnosed clinically. Postmortem cast angiography visualized 2 graft twists not possible to detect by autopsy dissection only. Surgical graft complications were the most frequent single cause for sudden postoperative hemodynamic collapse inCABGpatients leading to a fatal outcomein almost half of the cases. Postmortem angiography improved the accuracy of autopsy diagnostics of graft complications
Forensic Sci Med Pathol (2011) 7:9–13 DOI 10.1007/s12024-010-9189-2 Accepted: 19 August 2010 / Published online: 7 September 2010
