Post-mortem examination after cardiac surgery

Following a recent enquiry into surgery at a paediatric cardiac centre in E ngland, there will be substantial changes in the way that the success and f ailure of surgical procedures will be monitored and investigated. Post-mort em examinations on patients dying after cardiac surgery are likely to be pe rformed and reported in more detail. This review describes the protocol tha t we have developed and summarizes recent clinical and pathological studies that have increased our understanding of postoperative pathophysiology. Cl ose attention should be paid to the history, particularly the operation not e. Cardiac failure is the commonest cause of death. We believe this is a cl inicopathological diagnosis and provide definitions of preoperative and per ioperative cardiac failure. Haemorrhage, stroke, pulmonary emboli and infec tion are other important causes of death. Methods of dissection are suggest ed for bypass grafts and valve replacements. Two recent studies show that t he post-mortem examination provides answers to most clinical questions and reveals an unexpected cause of death in 10-15% of patients. There are limit ations however: an incomplete or indeterminate cause of death is found in 1 4-25% of patients, most commonly sudden clinically unexplained death or cli nically unexplained cardiac failure soon after surgery.