Clinical impact of computerised tomographic angiography performed for preoperative evaluation before coronary artery...

In our institution, computerised tomographic (CT) angiography has been performed as a near-routine test before coronary artery bypass grafting (CABG) to evaluate the aorta and its branches. We aimed to determine its impact on operative procedure and perioperative management.

From January 2006 through December 2008, neck-to-leg systemic arteries were evaluated by 64-slice multidetector CT scan in 284 patients before CABG. For them, medical records and cardiac surgery database were retrospectively reviewed to investigate the incidence of pathologic lesions of the aorta and its major branches, other incidental lesions and procedure- or management-related decision affected by CT angiography.

In 36 patients (12.7%), cannulation and clamping of the ascending aorta were thought too dangerous because of severe atherosclerotic change. The use of cardiopulmonary bypass was inevitable in 10 of them, and postoperative mortality rate was significantly higher (3/10, 30%) than in the remaining patients (2/274, 0.7%). Conduit selection or grafting strategy was changed due to severe left subclavian artery stenosis or leg vein varicosity in 18 patients (6.3%). For the following problems, surgical interventions were performed in 34 patients (12.0%) concomitantly or during the same admission with CABG; > or = 90% stenosis in carotid (5.6%), iliofemoral (11.6%) or renal (4.6%) arteries, aortic aneurysm (14.4%, six of them met surgical indication) and incidental malignant neoplasm (2.8%). Counting all of the above, preoperative CT angiography affected risk assessment, CABG procedure itself, perioperative management or follow-up plan in 142 patients (50%).

Because preoperative CT angiography considerably affected management in one half of patients, we recommend its use as a routine test before CABG, unless contraindicated.