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Thoracic computed tomography prior to redo coronary surgery
J Cremer1, O E Teebken, A Simon
1Department of Cardiovascular Surgery, Christian-Albrechts-University, Kiel, Germany.
Summary
Computed tomography (CT) scans improve preoperative assessment for redo coronary surgery, identifying risks and facilitating safer sternum reopening. This reduces the need for preventive measures like femoral vessel exposure.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Thoracic Surgery
Background:
- Median resternotomy in coronary artery bypass grafting (CABG) reoperations carries a risk of injury to retrosternal structures.
- Preoperative assessment is crucial for mitigating these risks.
Purpose of the Study:
- To evaluate the utility of computed tomography (CT) in assessing retrosternal structures before redo coronary surgery.
- To improve the safety of median resternotomy in repeat CABG procedures.
Main Methods:
- Retrospective analysis of thoracic CT scans from 99 patients undergoing coronary reoperations.
- Assessment of retrosternal cardiovascular structures, ascending aorta condition, and sternal abnormalities.
Main Results:
- Detailed measurements of distances between the sternum and the aorta/right ventricle were obtained.
- Ascending aorta calcification was identified in 56 patients.
- Despite close proximity in some cases, safe resternotomy was achieved, though innominate vein injury occurred in two patients.
Conclusions:
- Thoracic CT scanning provides a detailed preoperative assessment for redo coronary surgery.
- CT facilitates safer sternum reopening and may reduce the need for routine preventive femoral vessel exposure or lateral thoracotomies.