Search

Objective: Preoperative chest radiograph screening is widely used before cardiac surgery. The objective of this study was to investigate the frequency of abnormal findings on a routine chest radiograph before cardiac surgery., Methods: In this retrospective cohort study, 1136 patients were included. Patients were scheduled for cardiac surgery and underwent a preoperative chest radiograph. The primary outcome was the frequency of abnormalities on the chest radiograph. Secondary outcome was the effect of those abnormalities on surgery., Results: One half of the patients (570/1136; 50%) had 1 or more abnormalities on the chest radiograph. Most frequent abnormalities were cardiomegaly, aortic elongation, signs of chronic obstructive pulmonary disease, vertebral fractures or height loss, possible pulmonary or mediastinal mass, pleural effusion, and atelectasis. In 2 patients (2/1136; 0.2%), the chest radiograph led to postponement of surgery, whereas in none of the patients the surgery was cancelled. In 1 patient (1/1136; 0.1%) the surgical approach was altered and in 15 patients (15/1136; 1.3%) further analysis was performed without having an impact on the planned surgical approach., Conclusions: Although abnormalities are frequently found on preoperative chest radiographs before cardiac surgery, change in clinical management with regard to planned surgery or surgical approach occurs infrequently., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Stroke after cardiac surgery is a severe complication with a persistently high incidence of 1.4 - 9.7%. Postoperative strokes are mainly embolic and can be provoked by manipulation and clamping of the aorta during cardiac surgery, resulting in the mobilization of atherothrombotic material and calcifications from the aortic wall. Computed tomography (CT) can offer preoperative visualization of aortic calcifications with low radiation exposure. We hypothesize that preoperative knowledge regarding the location and extent of aortic calcifications can be used to optimize surgical strategy and decrease postoperative stroke rate., Methods/design: The CRICKET study (ultra low-dose chest CT with iterative reconstructions as an alternative to conventional chest x-ray prior to heart surgery) is a prospective multicenter randomized clinical trial to evaluate whether non-contrast chest CT before cardiac surgery can decrease postoperative stroke rate by optimizing surgical strategy. Patients scheduled to undergo cardiac surgery aged 18 years and older are eligible for inclusion. Exclusion criteria are pregnancy, a chest/cardiac CT in the past three months, emergency surgery, concomitant or prior participation in a study with ionizing radiation and unwillingness to be informed about incidental findings. Subjects (n = 1.724) are randomized between routine care, including a chest x-ray, or routine care with an additional low dose chest CT. The primary objective is to investigate whether the postoperative in-hospital stroke rate is reduced in the CT arm compared to the routine care arm of the randomized trial. The secondary outcome measures are altered surgical approach based on CT findings and cost-effectiveness., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate whether preoperative chest computed tomography (CT) decreases postoperative mortality and stroke rate in cardiac surgery by detection of calcifications and visualization of postoperative anatomy in redo cardiac surgery which can be used to optimize the surgical approach., Methods: The PubMed, EMBASE and Cochrane databases were searched and articles concerning preoperative CT in cardiac surgery were included. Articles not reporting mortality, stroke rate or change in surgical approach were excluded. Studies concerning primary cardiac surgery as well as articles concerning redo cardiac surgery were both included., Results: Eighteen studies were included (n=4057 patients) in which 2584 patients received a preoperative CT. Seven articles (n=1754 patients) concerned primary surgery and eleven articles (n=2303 patients) concerned redo cardiac surgery. None of the studies was randomized but 8 studies provided a comparison to a control group. Stroke rate decreased with 77-96% (primary surgery) and 18-100% (redo surgery) in patients receiving a preoperative CT. Mortality decreased up to 66% in studies investigating primary surgery while the effect on mortality in redo surgery varied widely. Change in surgical approach based on CT-findings consisted of choosing a different cannulation site, opting for off-pump surgery and cancellation of surgery., Conclusions: Current evidence suggests that preoperative CT imaging may lead to decreased stroke and mortality rate in patients undergoing primary cardiac surgery by optimizing surgical approach. In patients undergoing redo cardiac surgery stroke rate is also decreased but the effect on mortality is unclear. However, evidence is weak and included studies were of moderate quality., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)