Heart Surgery after an Out-of-the-Hospital Cardiac Arrest

Background: Cardiac surgery shortly after an out-of-hospital sudden cardiac death is rare. We reviewed our experience during the past decade.

Methods and Results: Between 2008 and 2018, 2690 adults had cardiac surgery in our institution. Using our departmental database we identified 12 patients (0.44%) who underwent cardiac surgery after a median of 5 days (range 0-18) from sudden cardiac death secondary to coronary artery disease, aortic stenosis, or both. Three patients (25%) presented with cardiogenic shock. Six patients (50%) had severely reduced LVEF. Median Glasgow Coma Scale upon arrival was 15 (4-15). Median time interval from admission to surgery was 5 days (0-18). The procedures performed included isolated CABG (8), isolated AVR (2), and combined AVR with CABG (2). AICD was implanted in six patients (50%). Thirty-day mortality was 0%. Three patients (25%) had major neurological complications – perioperative stroke (1), and diffuse ischemic brain injury (2). Follow-up was available for all patients (median 21.8 months, range 3-107). Eleven patients (91.7%) are still alive with an excellent functional class; one patient (8.3%) died from aspiration at a nursing home.

Conclusions: In carefully selected patients, cardiac surgery shortly after out-of-the hospital sudden cardiac death is safe and associated with excellent short and long-term outcomes. Optimal timing of surgery, choice of procedure, brain protection and the role of AICD implantation are among many questions that need to be further investigated in a much larger cohort.