Computed tomography follow-up after elective proximal aortic surgery: Less is more?
Delano J de Oliveira Marreiros1, Anton Tomšič1, Thomas J van Brakel1
1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
American Heart Journal
|April 18, 2022
Summary
Routine computed tomography (CT) follow-up after proximal aortic surgery is not always beneficial. Aorta-related complications are uncommon and often do not require reintervention, suggesting a conservative CT approach may be suitable.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Surgery
Background:
- The clinical utility of routine computed tomography (CT) surveillance following elective proximal aortic surgery remains uncertain.
- Assessing the impact of CT follow-up on detecting aorta-related complications and subsequent reinterventions is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To evaluate the added value of routine computed tomography (CT) follow-up after elective proximal aortic surgery.
- To determine the incidence of aorta-related complications and reinterventions detected during CT follow-up in patients who underwent proximal aortic surgery.
Main Methods:
- A retrospective analysis of 314 patients who underwent their first elective proximal aortic surgery between 2000 and 2015.
- Primary endpoints included aorta-related complications and reinterventions identified during routine CT follow-up; secondary endpoints encompassed all such events regardless of detection method, along with survival data.
- Median follow-up was 6.8 years with a median of 4 CT scans per patient.
Main Results:
- Aorta-related complications were detected in 5.7% of patients during CT follow-up, with 1.6% requiring reintervention.
- In total, 7.3% of patients experienced aorta-related complications, and 9 of these led to reintervention.
- Detecting one aorta-related complication leading to reintervention required 218 routine CT scans, indicating a low yield.
Conclusions:
- Aorta-related complications after first-time elective proximal aortic surgery are infrequent and often do not necessitate reintervention.
- Routine CT follow-up may not always detect clinically significant complications or lead to necessary reinterventions.
- Consideration of a more selective CT follow-up strategy could reduce radiation exposure and healthcare costs in specific patient groups.
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