Original article: cardiovascular
Reperfusion injury associated with one-fourth of deaths after coronary artery bypass grafting

https://doi.org/10.1016/S0003-4975(00)01638-6Get rights and content

Abstract

Background. This study of reperfusion injury after coronary artery bypass grafting focuses on its contribution to fatal outcome, on its connection with myocardial infarction (MI) and on risk factors.

Methods. A consecutive series of 190 patients (mean age 61.7 ± 8.9 years) dying within 30 days following coronary artery bypass grafting was autopsied with concomitant postmortem angiography during 1980 to 1993.

Results. Reperfusion injury was revealed in 49 (25.8%) patients, with concomitant MI in almost all (46 of 49) (p < 0.01). Reperfusion injury occurred in association with preoperative New York Heart Association (NYHA) III classification (p < 0.05), coronary endarterectomy (p < 0.01), long aortic clamping time (p < 0.01), and short postoperative survival (p < 0.05).

Conclusions. Reperfusion injury was observed in one fourth of the deaths in association with MI. It occurred more often in patients with preoperative NYHA III symptoms and in those in whom endarterectomy was carried out and the anoxic time of the myocardium was longer. The shorter postoperative survival time indicates the lethal nature of this complication.

Section snippets

Patients and methods

The study was approved by the institutional ethics committees. The original prospective series comprised 252 consecutive patients who had a fatal outcome within 30 days after CABG from 1980 to 1993 in all three cardiac centers (Helsinki University Central Hospital, the Deaconess Hospital and the Mehiläinen Hospital) in Helsinki. During this time the total of CABG procedures was 8,286. Autopsies were performed on all those with fatal outcome at the Department of Forensic Medicine, University of

Results

The mortality during 1980 to 1993 was 3.0%. Mortality was highest in 1983 (5.2%) and decreased thereafter year by year, being 1.7% during both the last years of the study.

Comment

Reperfusion injury is a common phenomenon associated with CABG 1, 2. Events related to this disease comprise arrhythmias, vascular damage, the no-reflow phenomenon, and myocardial functional stunning. Cell swelling and hastening of necrosis in cells already irreversibly damaged by ischemia are also ascribed to RI 3, 4. The mechanisms and pathogenesis by which the lesion is caused are complex and still uncertain. The two most important hypotheses explaining cellular events involved in RI are

Acknowledgements

This work has been supported by a research grant from the Finnish Society for Angiology. We are grateful to the staff of the Department of Forensic Medicine. We also thank Professor Ari Harjula from the Deaconess Hospital in Helsinki for his kind help in making hospital records available. We acknowledge Carol Norris, PhD, for the language revision.

Cited by (0)

View full text