Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke

Harder, Annemarie M. den; Heer, Linda M. de; Meijer, Rudy; Das, Marco; Krestin, Gabriël P.; Bogers, Ad J.J.C.; Jong, Pim A. de; Leiner, Tim; Budde, Ricardo P.J.

doi:10.1016/j.ejrad.2016.01.003

Cited by 22 publications

(35 citation statements)

References 43 publications

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“…While there are few reports on NCCCT and/or CD performed for patients prior to cardiac surgery in research studies, [3,4,7,8] to the best of our knowledge, our center is the rst to introduce this practice as a standard of care for all patients undergoing cardiac surgery. Pre-operative NCCCT and CD may assist in the surgical decision making and selection of optimal strategies to decrease perioperative stroke, morbidity and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…[3,4,7] Additionally, prior to resternotomy, NCCCT can delineate the anatomical relationship of mediastinal structures and their proximity to the posterior surface of the sternum, as well as identify previously placed coronary grafts that may be injured upon re-entry. [3,6,15] Patients with more atherosclerotic disease in the ascending aorta are signi cantly more likely to have a higher incidence of carotid artery disease. [12] Pre-operative CD evaluation can be used to identify signi cant atherosclerosis of the internal carotid artery, but is typically considered for high risk patients that are older than 80, have a carotid bruit, or have a history of cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

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The Routine Use of Preoperative Non-Contrast Chest Computerized Tomography and Carotid Arteries Doppler Prior to Cardiac Surgery

Nates¹,

Arazi²,

Grosman‐Rimon³

et al. 2021

Preprint

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Introduction: There is no consensus as to which patients should undergo Non-Contrast Chest Computerized Tomography (NCCCT) and carotid arteries Doppler (CD) prior to cardiac surgery. The objective of this study was to examine whether preoperative imaging modalities provide clinical benefits and a change in surgical strategy.Methods: We routinely performed NCCCT and CD in all non-urgent cardiac surgery patients. Major NCCCT/CD findings related to cardiovascular findings (aortic calcification/atherosclerosis, carotid artery plaque/stenosis), or other incidental findings (lung kidney, thyroid, adrenal, gastrointestinal sites etc.) were documented. The results were divided into 3 categories: (A) findings requiring both changes in surgical strategy and post-operative evaluation/treatment; (B) findings requiring changes in surgical strategy, but not requiring a specific post-operative evaluation/treatment; (C) findings not requiring changes in surgical strategy but requiring post-operative evaluation/treatment. Results: In this cohort, 93 (18.6%) out of 500 patients had significant cardiac and extra-cardiac findings on NCCCT and/or CD. Among the 93 patients with significant findings, 33.33% (31 patients, 6.2% of all patients) were in group A, 7.5% (7 patients, 1.4% of all patients) were in group B, and 59.14% (55 patients, 11% of all patients) were in group C. Change in surgical strategies included, for example, switching from planned on-pump Coronary Artery Bypass Graft surgery (CABG) to off-pump CABG and performing additional procedures to the originally planned heart surgery. Conclusion: Routine preoperative NCCCT and CD evaluation in all non-urgent cardiac surgical patients is an effective measure for uncovering cardiac and extra-cardiac findings prior to surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Routine Use of Preoperative Non-Contrast Chest Computerized Tomography and Carotid Arteries Doppler Prior to Cardiac Surgery

Nates¹,

Arazi²,

Grosman‐Rimon³

et al. 2021

Preprint

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“…Several studies that examined whether CT scan before cardiovascular surgery reduced complications showed that the CT imaging group changed the cannulation site for cardiopulmonary bypass and reported reduced complications [ 12 , 13 ]. Chest CT has also been reported to have a high sensitivity in diagnosing COVID-19 [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Absent right superior vena cava with persistent left superior vena cava in a patient with COVID-19

et al. 2021

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Vascular injury associated with cannulation during extracorporeal membrane oxygenation (ECMO) induction is a rare but life-threatening complication. The presence of abnormal vascular anatomy increases the risk of vascular injury and should be recognized before cannulation. We report the case of a patient with coronavirus disease (COVID-19) who was expected to undergo ECMO. By performing computed tomography (CT), we identified the absence of right superior vena cava (RSVC) with a persistent left superior vena cava (PLSVC) that could have caused serious complications associated with ECMO cannulation. PLSVC is observed in less than 0.5% of the general population; however, the combination of PLSVC and an absent RSVC in visceroatrial situs solitus is extremely rare. Attempting cannulation for Veno-venous (VV)-ECMO from the right (or left) internal jugular vein to the right atrium may cause serious complications. Cannulation may fail or lead to complications even in patients with inferior vena cava malformations. Although these vascular abnormalities are rare, it is possible to avoid iatrogenic vascular injury by identifying their presence in advance. Since anatomical variations in the vessels from the deep chest and abdominal cavity cannot be visualized using chest radiography and ultrasonography, we recommend CT, if possible, for patients with severe respiratory failure, including those with COVID-19, who may be considered for VV-ECMO induction.

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“…7 Intraoperative manual palpation of the aortic arch has only modest accuracy for detection of atheroma within the thoracic aorta 8 and intraoperative ultrasound has its limitation owing to narrow anatomical coverage and operator dependency. 9 Thoracic aortic calcification can be reliably quantified on CT 10 and several small studies have reported that preoperative CT in cardiac surgery may reduce postoperative stroke rate by altering surgical strategy and avoiding heavy manipulation of the aorta. 11 However, CT goes along with potentially harmful effects of radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta

Messerli

Giannopoulos

Leschka

et al. 2017

BJR

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A reliable estimation of calcified atherosclerotic burden of the thoracic aorta can be achieved with modern tin-filter CT at dose values comparable to chest direct radiography. Advances in knowledge: Our findings suggest that ultralow-dose CT is an excellent tool for assessing the calcified atherosclerotic burden of the thoracic aorta with higher diagnostic accuracy than conventional chest radiography and importantly without the additional cost of increased radiation dose.

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Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke

Cited by 22 publications

References 43 publications

The Routine Use of Preoperative Non-Contrast Chest Computerized Tomography and Carotid Arteries Doppler Prior to Cardiac Surgery

The Routine Use of Preoperative Non-Contrast Chest Computerized Tomography and Carotid Arteries Doppler Prior to Cardiac Surgery

Absent right superior vena cava with persistent left superior vena cava in a patient with COVID-19

Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta

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