Abstract 311: Impact of the Presence of High-risk Findings at Preoperative Multidetector Computed Tomographic Angiography Evaluation in Patients Undergoing Reoperative Cardiac Surgery
Background: Although cardiac CT prior to reoperative cardiac surgery is considered an “appropriate” imaging indication, there are no data on the relationship between the presence of CT scan findings and perioperative surgical outcomes.
Methods: We studied 364 patients undergoing reoperative cardiac surgery (RCS) between 2004 and 2008, including 136 clinically referred for cardiac CT. High-risk CT findings were defined as the presence of a bypass graft, the right ventricle or aorta <10 mm from the sternum, or a bypass graft that crosses the midline. The primary clinical endpoint was the composite of post-operative death, myocardial infarction, stoke, and urgent reoperation. Secondary endpoints included surgical procedural variables and the perioperative amount of bleeding and the rate of red blood cell (RBC) transfusion.
Results: Baseline clinical characteristics were similar between the patients with high-risk findings and those without them, including predicted operative morbidity and mortality using the STS score. The presence of high-risk findings was highly associated with both bleeding and adverse operative outcomes. The presence of any cardiac structure at high risk (n=104, 76.5%) was associated with an increased risk of blood loss (654 vs 528 cc, p=.04) and of RBC transfusion (668 vs 431 cc, p=.03) during the surgery. The presence of any graft at high-risk (n=21, 15.3%) was associated with the use of cannulation methods excluding the aorta (19% vs 0,9%, p <.001). The use of cardiac CT was associated with significantly shorter ICU and operative times, and was independently associated with improved surgical outcomes after controlling for the STS score.
Conclusion: Cardiac CT prior to reoperative cardiac surgery can detect high-risk substernal findings associated with a high risk of bleeding and other adverse surgical outcomes and should be used routinely in these patients as a guidance tool to improve overall surgical outcomes.