Preoperative Routine CT Screening of Patients at High Risk for Aortic Calcification Reduces Postoperative Stroke Rate

Objectives: The aim of this study is to determine whether preoperative noncontrast chest computed tomography (CT) to identify areas of aortic calcification in high-risk patients with optimization of operative strategies will help the reduce perioperative strokes.

Methods: In this retrospective case-control study, patients who underwent an open cardiosurgical procedure from April 2018 to May 2020 in a single institution were screened for inclusion. The inclusion criteria comprised age 75 years or older, peripheral vascular disease (PVD), significant carotid artery stenosis, and chronic dialysis. Patients were assigned to either group 1, which included all patients who were operated upon from April 2018 to April 2019 and received no preoperative CT, or group 2, who were operated upon from May 2019 to May 2020 and routinely underwent a native preoperative CT before surgery. The preoperative, operative, and postoperative results were prospectively collected and analyzed. The primary outcome was the occurrence of postoperative stroke. The secondary outcomes were change in surgical strategies based on the CT finding, reintubation and tracheostomy rates, and duration of hospital stay.

Result: Group 1 included 263 patients, while group 2 included 129. There were no significant preoperative differences in age, carotid stenosis, dialysis, PVD rates, atrial fibrillation, or history of cerebrovascular insults between the groups. Group 2 had a higher left ventricular ejection fraction (55 vs. 52%, p = 0.02). Intraoperatively, group 2 had a longer cardiopulmonary bypass time (121 ± 5 vs. 107 ± 4, p = 0.04). There were no differences in operative or aortic cross clamp times. Postoperatively, there was no significant difference regarding postoperative low cardiac output, rethoracotomy rates, or arrhythmias. Group 2 showed significantly lower stroke rates (3.0 vs. 8.4%, p = 0.035). In eight patients (6% of group 2), the surgical strategy was changed based on the CT finding; this included switching to beating heart surgery, OPCAB or TAVI. There were no significant differences in reintubations and tracheostomy rates or hospital stay.

Conclusion: Preoperative CT screening may help to decrease postoperative stroke rates in high risk patients undergoing primary cardiac surgery by optimizing surgical approach. In patients older than 75 years, history of PVD, carotid stenosis or dialysis a preoperative non-contrast chest computed tomography should be implemented whenever possible.

Publication History

Article published online:
19 February 2021