Prospective study of the value of necropsy examination in early death after cardiac surgery.

Lee, A. H. S.; B, Borek; Gallagher, P. J.; Saunders, Rachel; Lamb, Robert J.; Livesey, Steven; Tsang, VT; Monro, J L

doi:10.1136/hrt.78.1.34

Cited by 21 publications

(32 citation statements)

References 22 publications

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“…The incidence of anoxic brain damage defined as punctate cortical hemorrhage was 7.5% according to Herczeg et al [15], but somewhat lower in this study at 4.9%. On the other hand, our incidence of cerebral hemorrhage was low, only 0.7% compared with the 2.8% found by Lee et al [16] with 108 autopsy patients. Our low incidence of cerebral edema, 51%, compared to the 100% of Herczeg et al [15] is probably due to the definition of cerebral edema, as in the study of Herczeg et al the milder forms of edema were also included.…”

Section: Discussioncontrasting

confidence: 79%

Cerebral cast angiography as an aid to medicolegal autopsies in cases of death after adult cardiac surgery

Saimanen

Järvinen

Penttilä

2001

International Journal of Legal Medicine

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Due to an increase in age of the patient population in cardiac surgery, cerebral complications are increasing in frequency, also as a cause of death. In order to reveal cerebral pathology associated with a fatal outcome after cardiac surgery, we re-evaluated the cast angiographs and medico-legal autopsy documents of 144 adult cardiac surgery subjects over a 7-year period. Special attention was paid to the ability of post-mortem cast angiography to aid in diagnosing cerebral pathology. The autopsy detected new ischemic cerebral lesions in 29 (20%) cases, of which 22 (15.3%) were recent infarcts, and 7 were cases of anoxic brain damage. Of the recent cerebral infarcts, 12 were associated with cerebral artery thrombosis, 4 showed multiple lesions, and the remaining 6 were small single infarcts. In addition, one subject had an intracerebral hemorrhage and 72 (50%) cerebral edema. By cast angiography, the leakage of contrast medium in the case of intracerebral hemorrhage and stenoses of intracranial and cervical arteries could be well demonstrated and also revealed 17 (77%) of the 22 recent cerebral infarcts. It was found to be suitable for detecting recent brain infarcts associated with main cerebral artery thrombosis, with a sensitivity of 92% (11 out of 12 cases), but was less sensitive in showing small recent infarcts with a sensitivity of 60% (6 out of 10 cases) and inferior for the older ones where none of the 6 cases were detected. Filling defects caused by cerebral edema were difficult to differentiate from technical errors and were encountered in 7 (4.8%) cases. A significant predictor for the 29 recent ischemic brain lesions was perioperative hypotension. The immediate cause of death was most often of cardiac (83%) and cerebral (14%) origin. In 14 cases, cerebral damage was considered to be an additional cause of death. The use of cerebral post-mortem cast angiography should be recommended, especially for its excellent ability to visualize intravascular pathology such as arterial stenoses and thromboses, with a 92% sensitivity in showing new main cerebral artery thromboses, before likely distortion of the vascular anatomy by dissection.

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Section: Discussioncontrasting

confidence: 79%

Cerebral cast angiography as an aid to medicolegal autopsies in cases of death after adult cardiac surgery

Saimanen

Järvinen

Penttilä

2001

International Journal of Legal Medicine

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“…Despite extensive investigations in this field since the introduction of CABG in the late 1960s, only relatively few clinicopathological studies on causes of death and complications have yet been reported [6,16,18,29]. This may partly be explained by the fact that in the last decades the autopsy rate has shown continual declination in the western world.…”

Section: Discussionmentioning

confidence: 82%

Mechanisms of death in the early postoperative period following coronary artery bypass grafting for acquired heart disease. A clinicopathological study of 32 cases

Glasz

Frenken²,

Knieriem

et al. 2003

Virchows Archiv

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“…1 After cardiac surgery, VTE has been reported as a common cause of postoperative death, [2][3][4] and it is the fifth most common reason for hospital readmission after coronary artery bypass graft surgery (CABG). 5 Recent reports in the cardiac surgery literature have documented rates of clinically apparent VTE ranging from 0.5% to 1.3%, [5][6][7][8] although higher rates have been seen in studies using routine postoperative ultrasound surveillance.…”

mentioning

confidence: 99%

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Kulik

Rassen

Myers

et al. 2012

Circ: Cardiovascular Interventions

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Background-Controversy exists regarding the optimal preventative therapy for venous thromboembolism (VTE) after coronary artery bypass graft (CABG) surgery. We sought to compare the effectiveness and safety of the most commonly used regimens. Methods and Results-We assembled a cohort of 92 699 patients who underwent CABG between 2004 and 2008, using the Premier database. Patients were categorized by method of VTE prevention initiated within 48 hours of surgery, including no preventative therapy (n=55 400), mechanical preventative therapy (n=21 162), subcutaneous unfractionated or low-molecular-weight heparin (n=10 718), subcutaneous fondaparinux (n=88), and concurrent mechanicalchemical therapy (n=5331). The incidence of VTE and major bleeding events within 6 weeks of CABG were compared, using multivariable and propensity score adjustment. The overall incidence of VTE for the entire cohort was 0.74%, and the incidence of major bleeding was 1.43%. VTE and bleeding events occurred with similar incidence in each of the patient categories (VTE: 0.70%, 0.79%, 0.81%, 1.14%, and 0.73%; major bleeding: 1.36%, 1.45%, 1.69%, 3.41%, 1.50%; no prevention, mechanical prevention, subcutaneous heparin, subcutaneous fondaparinux, concurrent mechanical-chemical prevention, respectively). Compared with receiving no prevention, the use of mechanical prevention or subcutaneous heparin did not significantly reduce the risk of VTE or change the risk of major bleeding (P=NS). Conclusions-Venous thromboembolism occurs infrequently after CABG. Compared with the use of no prevention, the administration of chemical or mechanical preventative therapies to CABG patients does not appreciably lower the risk of VTE. These data provide support for the common practice of administering no VTE preventative therapy after CABG, used for nearly 60% of patients within this cohort. (Circ Cardiovasc Interv. 2012;5:590-596.)

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Prospective study of the value of necropsy examination in early death after cardiac surgery.

Cited by 21 publications

References 22 publications

Cerebral cast angiography as an aid to medicolegal autopsies in cases of death after adult cardiac surgery

Cerebral cast angiography as an aid to medicolegal autopsies in cases of death after adult cardiac surgery

Mechanisms of death in the early postoperative period following coronary artery bypass grafting for acquired heart disease. A clinicopathological study of 32 cases

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

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