Routine Preoperative Screening Computed Tomography of the Thorax for Cardiac Surgery

Purpose: This study aims to evaluate the role of screening computed tomography (CT) thorax in cardiac surgery by analysing presence of CT aortic calcifications in association with change of operative strategy and postoperative stroke, as well as CT features of emphysema with development of pneumonia.Methods: All patients who underwent cardiac surgery from January 2013 to October 2017 by a single surgeon were retrospectively studied. Patients who underwent screening CT thorax prior to cardiac surgery (CT group) were compared with those who did not (no CT group). Multivariate subgroup analyses were performed to determine significant association with postoperative outcomes.Results: 392 patients were included, of which 156 patients underwent preoperative screening CT thorax. Patients in the CT group were older (63.9 vs 59.0 years, p=0.001), had fewer recent myocardial infarction preoperatively (41 vs 56.4%, p=0.003) and better ejection fraction >30% (p=0.02). Operative strategy was changed in 4.3% of patients, and 4.9% suffered stroke postoperatively. Presence of CT aortic calcifications was significantly associated with change in operative strategy (OR 1.54, p=0.016) but not associated with postoperative stroke (OR 0.53, p=0.33). Age was an independent risk factor for change in operative strategy among patients with CT thorax (p=0.02). Multivariate age-adjusted analysis showed only palpable plaque to be significantly associated with change in operative strategy (p<0.001). None of the patients with CT emphysema features developed pneumonia.Conclusion: The results do not support routine use of preoperative screening CT thorax. It should only be recommended in older patients.