Preoperative noncontrast chest computed tomography identifies potential aortic emboli

Area of Science:

• Cardiovascular Surgery
• Neuroradiology
• Vascular Surgery

Background:

• Intraoperative epiaortic scanning detects aortic atheroma, but its utility is limited as it's performed after sternotomy.
• Avoiding manipulation of aortic atheroma is crucial for reducing cerebral vascular accidents (CVA).
• Preoperative identification of at-risk aortic areas could optimize surgical strategy.

Purpose of the Study:

• To determine if preoperative noncontrast chest computed tomography (CT) can identify aortic areas prone to embolization in high-risk patients.
• To assess if operative strategies, informed by CT findings, can reduce permanent strokes by minimizing aortic manipulation.

Main Methods:

• A single-institution retrospective study compared stroke rates in two periods: pre-CT (January 2002-June 2003) and post-CT (July 2003-December 2005).
• In the post-CT period, 114 high-risk patients (defined by CVA history, peripheral vascular disease, etc.) received preoperative noncontrast chest CT.
• Stroke rates were compared using the chi-squared method.

Main Results:

• Preoperative CT identified significant ascending aortic calcifications in 20 of 114 high-risk patients.
• Operative strategies were altered in 19 of these patients, including increased use of axillary artery cannulation and off-pump procedures.
• The permanent stroke rate decreased significantly from 3.04% in the pre-CT period to 0.73% in the post-CT period (p = 0.05).

Conclusions:

• Preoperative CT screening effectively identifies high-risk aortic atheroma in patients undergoing cardiac surgery.
• Targeted operative strategies to avoid manipulating identified atheroma significantly reduce the incidence of permanent strokes.
• This approach enhances intraoperative screening and facilitates a more aggressive strategy to bypass calcified aortic segments.