Original article: cardiovascularReperfusion injury associated with one-fourth of deaths after coronary artery bypass grafting
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.
References (19)
- et al.
Effect of supplementing cardioplegic solution with deferoxamine on reperfused human myocardium
J Thorac Cardiovasc Surg
(1990) - et al.
Assessment of myocardial oxidative stress in patients after myocardial revascularization
Am Heart J
(1988) - et al.
Effects of repeated low calcium perfusion on the rat hearta gradual induction of calcium related damage
J Mol Cell Cardiol
(1990) Role of selectins in myocardial ischemia-reperfusion injury
Ann Thorac Surg
(1995)- et al.
Coronary artery endothelial dysfunction after global ischemia, blood cardioplegia, and reperfusion
Ann Thorac Surg
(1994) - et al.
Coronary artery endothelial function after myocardial ischemia and reperfusion
Ann Thorac Surg
(1995) - et al.
Myocardial protection for coronary bypass graftingthe Toronto hospital perspective
Ann Thorac Surg
(1995) Update on current techniques of myocardial protection
Ann Thorac Surg
(1995)- et al.
The physiologic basis of warm cardioplegia
Ann Thorac Surg
(1995)