Assessing Retrosternal Adhesions Using Preoperative CT to Predict Cardiovascular Injury During Sternotomy

Area of Science:

• Cardiovascular Surgery
• Radiology
• Medical Imaging

Background:

• Intraoperative cardiovascular injury during sternotomy poses significant risks.
• Identifying patients at high risk is crucial for surgical planning.

Purpose of the Study:

• To identify preoperative CT findings associated with retrosternal adherence-related intraoperative cardiovascular injury.
• To develop predictive scores for guiding surgical planning.

Main Methods:

• Retrospective study of 429 patients undergoing CT within 30 days of sternotomy (2019-2023).
• CT image review for retrosternal adherence patterns (distance, contact, adherence) and location (segment or organ).
• Logistic regression to identify predictors and develop CAST and ARCA scores.

Main Results:

• 105 patients (24%) experienced cardiovascular injuries.
• Significant predictors included middle third adherence, calcification, and age (segment approach).
• Aortic/right atrial adherence, calcification, and age were significant (organ-specific approach).
• CAST (Calcification, Age, Sternal Thirds) and ARCA (Aorta, Right Atrium, Calcification, Age) scores were derived.

Conclusions:

• Preoperative CT effectively identifies patients at high risk for intraoperative cardiovascular injury.
• The CAST and ARCA scores provide a reliable CT-based risk assessment.
• These scores can enhance surgical planning and preemptive interventions for improved outcomes in high-risk cardiac reoperations.