title: Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke.
abstract: OBJECTIVE
  To investigate whether preoperative chest computed tomography (CT) decreases postoperative mortality and stroke rate in cardiac surgery by detection of calcifications and visualization of postoperative anatomy in redo cardiac surgery which can be used to optimize the surgical approach.
  
  
  METHODS
  The PubMed, EMBASE and Cochrane databases were searched and articles concerning preoperative CT in cardiac surgery were included. Articles not reporting mortality, stroke rate or change in surgical approach were excluded. Studies concerning primary cardiac surgery as well as articles concerning redo cardiac surgery were both included.
  
  
  RESULTS
  Eighteen studies were included (n=4057 patients) in which 2584 patients received a preoperative CT. Seven articles (n=1754 patients) concerned primary surgery and eleven articles (n=2303 patients) concerned redo cardiac surgery. None of the studies was randomized but 8 studies provided a comparison to a control group. Stroke rate decreased with 77-96% (primary surgery) and 18-100% (redo surgery) in patients receiving a preoperative CT. Mortality decreased up to 66% in studies investigating primary surgery while the effect on mortality in redo surgery varied widely. Change in surgical approach based on CT-findings consisted of choosing a different cannulation site, opting for off-pump surgery and cancellation of surgery.
  
  
  CONCLUSIONS
  Current evidence suggests that preoperative CT imaging may lead to decreased stroke and mortality rate in patients undergoing primary cardiac surgery by optimizing surgical approach. In patients undergoing redo cardiac surgery stroke rate is also decreased but the effect on mortality is unclear. However, evidence is weak and included studies were of moderate quality.
authors.affiliation: Department of Radiology, University Medical Center, P.O. Box 85000, 3508 GA Utrecht, The Netherlands. Electronic address: a.m.denharder@umcutrecht.nl.
authors.forename: Annemarie M
authors.initials: AM
authors.lastname: den Harder
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, P.O. Box 85000, 3508 GA Utrecht, The Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: de Heer
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, P.O. Box 85000, 3508 GA Utrecht, The Netherlands.
authors.forename: Ronald C A
authors.initials: RC
authors.lastname: Meijer
authors.affiliation: Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Das
authors.affiliation: Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.affiliation: Department of Radiology, University Medical Center, P.O. Box 85000, 3508 GA Utrecht, The Netherlands.
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.affiliation: Department of Radiology, University Medical Center, P.O. Box 85000, 3508 GA Utrecht, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.affiliation: Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D020521:Stroke / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Aortic calcifications; Cardiac surgery; Computed tomography; Stroke