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Published on: August 28, 2018
Preoperative Chest Computed Tomography Screening Reduces the Perioperative Stroke Rate in Patients at Risk of Aortic
Tamer Ghazy1, Maximillian Vondran2, Marc Irqsusi1
1Department of Cardiac and Thoracic-Vascular Surgery, University Hospital Gießen and Marburg, Philipps University of Marburg, 35043 Marburg, Germany.
Insights
Preoperative chest computed tomography (CT) screening for patients undergoing heart surgery can reduce stroke risk. This imaging helps adapt surgical strategies, leading to better patient outcomes and fewer strokes.
Area of Science:
- Cardiovascular Surgery
- Radiology
- Neurosurgery
Background:
- Aortic calcification poses a stroke risk in cardiosurgical patients.
- Perioperative stroke is a significant complication in cardiac surgery.
- The role of preoperative imaging in mitigating this risk is crucial.
Purpose of the Study:
- To evaluate the impact of preoperative chest computed tomography (CT) screening on perioperative stroke rates.
- To assess the influence of CT findings on surgical strategy in at-risk patients.
Main Methods:
- A prospective cohort (Group 1) of 129 patients underwent non-contrast chest CT screening.
- A historical cohort (Group 2) of 261 patients did not have preoperative CT screening.
- Primary endpoint: postoperative stroke occurrence. Secondary endpoints: reintubation, hospital stay, surgical strategy changes.
Main Results:
- The CT screening group (Group 1) experienced a significantly lower stroke rate compared to the non-CT group (Group 2).
- Surgical strategy was modified for 6 patients based on CT findings.
- No significant differences in reintubation rates or hospital stay were observed between groups.
- Independent stroke risk factors identified: lack of CT screening, advanced age, aortic valve/surgery, and rethoracotomy.
Conclusions:
- Preoperative non-contrast chest CT screening effectively reduces postoperative stroke in cardiosurgical patients with aortic calcification risk.
- Routine use of CT screening is recommended to allow surgical approach adaptation and improve patient safety.
Objectives:
We evaluated the effect of preoperative chest computed tomography (CT) screening on the perioperative stroke rate in cardiosurgical patients at risk of aortic calcification.
Methods:
Between May 2019 and April 2020, 129 patients at risk of aortic calcification underwent non-contrast chest CT screening before their procedure. They were assigned to Group 1 and compared with a historical Group 2, who were treated the previous year without a preoperative CT scan. The primary endpoint was to determine postoperative stroke occurrence. The secondary outcomes were the rate reintubation/tracheostomy, the length of hospital stay, and any change in surgical strategy based on the CT findings.
Results:
Groups 1 and 2 comprised 129 and 261 patients, respectively. Group 1 had a lower left ventricular ejection fraction, less carotid stenosis, a history of carotid endarterectomy, and a longer cross-clamp time. The surgical strategy was changed for 6 patients in Group 1. Group 1 had a significantly lower stroke rate. No significant differences were observed in reintubation and tracheostomy rates, or length of hospital stay. Lack of CT screening, age, aortic valve surgery, aortic surgery, and rethoracotomy were identified as independent risk factors for a stroke.
Conclusions:
Preoperative non-contrast chest CT screening of patients at risk of aortic calcification reduces postoperative stroke through adaptation of the surgical approach and should be used routinely in these patients.
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Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...