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Ann Thorac Surg 2000;70:807-812
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Reperfusion injury associated with one-fourth of deaths after coronary artery bypass grafting

Saara M. Weman, MDb, Pekka J. Karhunen, MDc,d, Antti Penttilä, MDa, Antero A. Järvinen, MD, PhDb, Ulla-Stina Salminen, MDb

a Department of Forensic Medicine, Helsinki University, Helsinki, Finland
b Department of Surgery, Helsinki University Hospital, Helsinki, Finland
c School of Medicine, University of Tampere, Tampere, Finland
d Department of Clinical Pathology and Forensic Medicine, University of Kupio, Kupio, Finland

Address reprint requests to Dr Salminen, Department of Surgery, PL 340, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, FIN-00029 HYKS, Finland
e-mail: ulla.s.salminen{at}netsonic.fi

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.




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