Sudden cardiac death after coronary artery bypass grafting

Introduction: Despite improvements in the care of patients with various heart diseases requiring surgical intervention, sudden cardiac death (SCD) remains a lethal complication. It was generally attributed to acute graft occlusion, cardiac tamponade, severe left ventri-cular (LV) dysfunction, graft disinsertion, arrhythmias, aortic dissection, acute valvular dysfunction or acute pulmonary embolism.

Objective: The aims of the current study are to analyze SCD cases that occurred after coronary artery bypass grafting (CABG) of the left anterior descending artery (LAD) at the Cardiovascular Diseases Institute from Iasi, Romania and to identify potential causes of SCD following CABG.

Methods: T he authors analyzed 2808 patients that benefited from CABG involving grafting of the LAD between 2000-2018. A total of 89 patients (3.17%) (24 females, 65 males, mean age 63.42 ± 14.42 years), died in the postoperative period, 5 of sepsis, 19 of multiple organ dysfunction syndrome, 1 suicide, 49 of cardiac causes and 15 of causes unmentioned in the medical files.

Results: In case of patients who died of cardiac cau-ses, 32 had a poor preoperative state and benefited from emergency surgery for mechanical complications associated with acute myocardial infarction. From the rest of 17 patients, 12 developed severe postoperative complications (7 acute renal failure, 3 acute myocardial infarction, 1 prolonged intubation of 261 hours, 1 atrial fibrillation). Only 5 cases who died of suddenly instal-led malignant arrhythmias had no pre or postoperative risk factor. In case of the 15 patients where the cause of death was not mentioned in the medical records, 12 had pre or postoperative risk factors (6 postoperative acu-te myocardial infarctions, 1 preoperative critical state, 1 emergency CABG, 2 postoperative atrial fibrillation, 1 postoperative stroke, 1 postoperative acute renal fa-ilure). In 3 cases, no risk factors have been identified. Finally, only 8 (8.99%) of the 89 postoperative deaths can be considered SCD.

Conclusions: In conclusion, there is a lack of standar-dization of SCD in certificate coding and definition and confusion in diagnosis of SCD following cardiac sur-gery is plurifactorial.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)