Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.
BACKGROUND
Preoperative evaluation with contrast-enhanced multidetector computed tomographic angiography (MDCTA) is considered an "appropriate" indication based on expert consensus. We aimed to evaluate how the presurgical evaluation with MDCTA impacts the outcomes after reoperative cardiac surgery (RCS).


METHODS
We retrospectively studied 364 patients undergoing RCS between 2004 and 2008, including 137 referred for MDCTA. High-risk CT findings were defined as the presence of right ventricle or aorta <10 mm from the sternum or a bypass graft <10 mm from the sternum crossing the midline. The primary clinical end point was the composite of perioperative death, myocardial infarction (MI), stoke, and hemorrhage-related reoperation. Secondary end points included surgical procedural variables and the perioperative volume of bleeding and of red blood cell (RBC) transfusion.


RESULTS
Baseline clinical characteristics were similar between the 2 groups. Individuals referred for MDCTA showed a trend toward a lower incidence of the composite primary end point (17.5% vs 24.2%, P = .13), primarily related to a significantly lower incidence of perioperative MI (0% vs 5.7%, P = .002). Multidetector computed tomographic angiography was also associated with shorter perfusion (90 vs 110 minutes, P = .002), cross clamp time (63 vs 75 minutes, P = .003), and total time in intensive care unit (103 vs 148 hours, P = .04), and a lower volume of postoperative RBC transfusion (627 vs 824 mL, P = .09). These differences remained significant after adjustment for the Society of Thoracic Surgeons score and the performing surgeon.


CONCLUSIONS
The use of MDCTA before RCS was associated with shorter perfusion and cross clamp time, shorter intensive care unit stays, and less frequent perioperative MI.
Maluenda
Gabriel
G
Noninvasive Cardiovascular Imaging, Department of Medicine/Cardiology, Washington Hospital Center, 110Irving Street NW,Washington, DC 20010, USA.
Goldstein
Matthew A
MA
Lemesle
Gilles
G
Weissman
Gaby
G
Weigold
Guy
G
Landsman
Marc J
MJ
Hill
Peter C
PC
Pita
Francisco
F
Corso
Paul J
PJ
Boyce
Steven W
SW
Pichard
Augusto D
AD
Waksman
Ron
R
Taylor
Allen J
AJ
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome