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Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.

Abstract：

BACKGROUND:Preoperative evaluation with contrast-enhanced multidetector computed tomographic angiography (MDCTA) is considered an "appropriate" indication based on expert consensus. We aimed to evaluate how the presurgical evaluation with MDCTA impacts the outcomes after reoperative cardiac surgery (RCS). METHODS:We retrospectively studied 364 patients undergoing RCS between 2004 and 2008, including 137 referred for MDCTA. High-risk CT findings were defined as the presence of right ventricle or aorta <10 mm from the sternum or a bypass graft <10 mm from the sternum crossing the midline. The primary clinical end point was the composite of perioperative death, myocardial infarction (MI), stoke, and hemorrhage-related reoperation. Secondary end points included surgical procedural variables and the perioperative volume of bleeding and of red blood cell (RBC) transfusion. RESULTS:Baseline clinical characteristics were similar between the 2 groups. Individuals referred for MDCTA showed a trend toward a lower incidence of the composite primary end point (17.5% vs 24.2%, P = .13), primarily related to a significantly lower incidence of perioperative MI (0% vs 5.7%, P = .002). Multidetector computed tomographic angiography was also associated with shorter perfusion (90 vs 110 minutes, P = .002), cross clamp time (63 vs 75 minutes, P = .003), and total time in intensive care unit (103 vs 148 hours, P = .04), and a lower volume of postoperative RBC transfusion (627 vs 824 mL, P = .09). These differences remained significant after adjustment for the Society of Thoracic Surgeons score and the performing surgeon. CONCLUSION:The use of MDCTA before RCS was associated with shorter perfusion and cross clamp time, shorter intensive care unit stays, and less frequent perioperative MI.

journal_name

Am Heart J

journal_title

American heart journal

authors

Maluenda G,Goldstein MA,Lemesle G,Weissman G,Weigold G,Landsman MJ,Hill PC,Pita F,Corso PJ,Boyce SW,Pichard AD,Waksman R,Taylor AJ

doi

10.1016/j.ahj.2009.11.005

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

301-6

issue

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(09)00877-1

journal_volume

159

pub_type

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Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.