Open heart reoperations after coronary artery bypass grafting: the role of preoperative imaging with multidetector computed tomography.
BACKGROUND
Injury to patent grafts or cardiac chambers may occur during reoperation after coronary artery bypass grafting. Preoperative spatial localization of bypass grafts with computed tomography may improve the safety of these procedures.


OBJECTIVE
To characterize patients who undergo CT before repeat operations after previous coronary artery bypass grafting, and evaluate its benefit in terms of surgical outcome.


METHODS
We compared 28 patients who underwent cardiac gated CT angiography before reoperation (CT group) to 45 redo patients who were not evaluated with CT (no-CT group).


RESULTS
The two groups were similar in most preoperative and operative characteristics. The CT group, however, included more patients with patent saphenous vein grafts and fewer with emergency operations, acute myocardial infarction and need for intraaortic balloon pump support. During mid-sternotomy, there was no injury to grafts in the CT group, while there were two patent grafts and three right ventricular injuries in the no-CT group. There was no significant difference in perioperative mortality (3.6% vs. 8.9%). The overall complication rate in the CT group was 21.4% compared to 42.2% in the no-CT group (P = 0.07). The only independent predictors of postoperative complications were diabetes mellitus, preoperative stroke and preoperative acute MI.


CONCLUSIONS
The patency and proximity of patent grafts to the sternum are well demonstrated by multidetector CT and may provide the surgeon with an important roadmap to avoid potential graft injury. A statistical trend towards reduced complications rate was demonstrated among patients who underwent CT angiography before their repeat cardiac operation. Larger series are required to demonstrate a statistically validated complication-free survival benefit of preoperative CT before repeat cardiac surgery.
Aviram
Galit
G
Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. aviramgalit@hotmail.com
Mohr
Rephael
R
Sharony
Ram
R
Medalion
Benjamin
B
Kramer
Amir
A
Uretzky
Gideon
G
D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency