Noninvasive Cardiovascular Imaging, Department of Medicine/Cardiology, Washington Hospital Center, 110Irving Street NW,Washington, DC 20010, USA.
Am Heart J. 2010 Feb;159(2):301-6. doi: 10.1016/j.ahj.2009.11.005.
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).
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.
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.
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.
基于专家共识，术前增强多排螺旋 CT 血管造影（MDCTA）检查被认为是一种“适当的”适应证。我们旨在评估 MDCTA 术前评估对再次心脏手术后（RCS）结果的影响。
我们回顾性研究了 2004 年至 2008 年间进行 RCS 的 364 例患者，其中 137 例患者接受 MDCTA 检查。高危 CT 发现定义为右心室或主动脉距胸骨 <10mm 或旁路移植术距胸骨 <10mm 穿过中线。主要临床终点是围手术期死亡、心肌梗死（MI）、中风和与出血相关的再次手术的复合终点。次要终点包括手术操作变量以及围手术期出血量和红细胞（RBC）输血量。
两组患者的基线临床特征相似。接受 MDCTA 检查的患者复合主要终点发生率呈下降趋势（17.5% vs. 24.2%，P =.13），主要与围手术期 MI 发生率显著降低相关（0% vs. 5.7%，P =.002）。MDCTA 还与灌注时间（90 分钟 vs. 110 分钟，P =.002）、体外循环时间（63 分钟 vs. 75 分钟，P =.003）和重症监护病房时间（103 小时 vs. 148 小时，P =.04）较短以及术后 RBC 输血量（627 毫升 vs. 824 毫升，P =.09）较少相关。在校正胸外科医生协会评分和手术医生后，这些差异仍然显著。
RCS 前使用 MDCTA 与较短的灌注和体外循环时间、较短的重症监护病房住院时间以及较少发生围手术期 MI 相关。
