Nishi Hiroyuki, Mitsuno Masataka, Tanaka Hiroe, Ryomoto Masaaki, Fukui Shinya, Miyamoto Yuji
Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 661-8501, Japan.
Interact Cardiovasc Thorac Surg. 2010 Jul;11(1):30-3. doi: 10.1510/icvts.2009.231761. Epub 2010 Apr 1.
Although chest computed tomography (CT) is useful for identifying ascending aortic calcification before surgery, the efficacy of routine preoperative CT in cardiac surgery is unknown. We sought to clarify the role of routine preoperative chest CT for the determination of ascending aortic calcification before cardiac surgery to aid in the prevention of stroke. Three hundred consecutive patients who underwent elective cardiac operations excluding thoracic aortic surgery had preoperative non-contrast CT. Thirteen patients (4.3%) had severe calcification in the ascending aorta which required alteration of the cannulation site. Univariate analysis showed preoperative renal dysfunction, dialysis and aortic stenosis as predictors for ascending aortic calcification, but not history of stroke, peripheral vascular disease, and age. In multivariate analysis, aortic stenosis was found as the only predictor. The prevalence of severe ascending aortic calcification was 11.9% (10/84) in patients with aortic stenosis. Stroke occurred in two (0.67%) of the patients in the entire group but none in the 13 patients with surgical modification. For patients with aortic stenosis or hemodialysis, a low postoperative stroke rate can be achieved in elective cardiac surgery by use of routine preoperative chest CT to identify patients with ascending aortic calcification who require modification of the surgical technique.
虽然胸部计算机断层扫描（CT）有助于在手术前识别升主动脉钙化，但术前常规CT在心脏手术中的有效性尚不清楚。我们试图阐明术前常规胸部CT在心脏手术前确定升主动脉钙化方面的作用，以帮助预防中风。连续300例接受择期心脏手术（不包括胸主动脉手术）的患者进行了术前非增强CT检查。13例患者（4.3%）升主动脉有严重钙化，需要改变插管部位。单因素分析显示术前肾功能不全、透析和主动脉瓣狭窄是升主动脉钙化的预测因素，但中风史、外周血管疾病和年龄不是。多因素分析发现主动脉瓣狭窄是唯一的预测因素。主动脉瓣狭窄患者中严重升主动脉钙化的患病率为11.9%（10/84）。全组有2例患者（0.67%）发生中风，但13例接受手术改良的患者中无一例发生中风。对于主动脉瓣狭窄或接受血液透析的患者，在择期心脏手术中，通过术前常规胸部CT识别需要改变手术技术的升主动脉钙化患者，可以实现较低的术后中风发生率。
