Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery

Abstract

Preoperative computed tomography (CT) use appears to be increasing among patients undergoing cardiac reoperations. We hypothesized that preoperative CT imaging reduces adverse outcomes and operative mortality for these patients. From July 2002 to February 2009, 373 patients underwent cardiac reoperations. Patients were stratified according to those with preoperative CT imaging (CT, n=140) and to those without preoperative CT imaging (NCT) (NCT, n=233). Preoperative risk, operative features, and postoperative outcomes were evaluated. Operative mortality for all cardiac reoperations was 7.5%. Patient risk factors were similar between CT and NCT groups. Preoperative imaging was more commonly performed for reoperative isolated valve operations (CT=70% vs. NCT=55.8%, P=0.01) but less commonly performed for reoperative isolated coronary artery bypass grafting (CABG) operations (14.3% vs. 22.7%, P=0.05). Postoperative renal failure, prolonged ventilation and operative mortality were similar between groups. Importantly, perioperative stroke occurred only within the NCT group (5.6% vs. 0.0%, P=0.003), and emergent operative status [odds ratio (OR): 6.45, confidence interval (CI): 1.15–36.10, P=0.03] as an independent multivariate predictor of perioperative stroke. Thus, preoperative CT imaging is associated with lower rates of perioperative stroke in patients undergoing cardiac reoperations by optimizing cannulation and aortic clamping strategies. Routine use of preoperative CT should be considered for patients undergoing cardiac operations following prior sternotomy.

Assessment of the Clinical Usefulness of Preoperative Computed Tomography in Colorectal Cancer Patients Who Received Unplanned Reoperation

“…According to the comparison between the operation results of the patients and the previous CT results, if they are consistent, they are true positive, if not, they are false positive. Categorical variables were compared using either Pearson's chi-squared test or Fisher's exact tests, and continuous variables were compared by Student's t -test for normally distributed data or Mann-Whitney's U -test for non-normally distributed data where appropriate [ 10 ]. All categorical variables were expressed as percentage within the group, and continuous variables were expressed as mean ± standard deviation (S.D.)…”

Vascular CT and MRI: a practical guide to imaging protocols

“…Performing a CTA prior to re-do cardiac surgery, with extra-cranial coverage to include the origin of the internal mammary arteries, allows identification of the location and can help surgeons alter surgical strategy, reducing the risk of intra-operative injury and improve outcomes [ 80 , 81 ].…”

Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

“…This analysis suggests that a history of previous cardiac surgery does not independently confer a significant incremental risk of operative mortality, but that patients with greater number of previous operations appear to be at higher risk." 1(p2) Several strategies for risk reduction in mortality and morbidity during resternotomy are described 8 : Polytetrafluoroethylene membrane, 3 preoperative chest computed tomography (CT), [9][10][11][12] use of an oscillating saw, 10,13 and peripheral cannulation. 10,11,14 The aim of this study was to describe the experience in reoperation of pediatric patients with congenital heart disease (CHD) in a center from a low-middle-income country and to determine the factors associated with operative mortality.…”

“…1 Many centers use preoperative CT in a routine manner or in high-risk patients to develop a surgical plan in order to decrease the probability of cardiac injury during repeat sternotomy. [9][10][11][12] However, this type of preoperative evaluation increases the costs of each procedure and in a health system with limited resources such as ours, it represents an additional cost that is difficult to afford. In this study, we found that preoperative CT is not always necessary to achieve good results, using only a preoperative chest X-ray and angiogram to assess the relationship between cardiac structures and the sternum.…”