The Use of Preoperative Non-Contrast Chest Computerized Tomography and Carotid Arteries Doppler in Cardiac Surgery Patients

Introduction: Routine use of non-contrast chest computerized tomography (NCCCT) and carotid arteries Doppler (CD), prior to cardiac surgery, may assist in surgical decision making in order to decrease morbidity and mortality. However, there is no clear consensus as to which patients should undergo this preoperative evaluation. The objective of this study was to examine whether routine use of these preoperative modalities provide clinical benefits and a change in surgical strategy in patients scheduled for cardiac surgery.

Material and Methods: From 2015 to 2019, we routinely preformed NCCCT and CD to all non-urgent cardiac surgery patients regardless of age and risk factors. All major cardiovascular or incidental findings (aortic calcification/atherosclerosis, carotid artery plaque/stenosis, lung, kidney, thyroid, adrenal, gastrointestinal sites etc.) were documented and divided into 3 categories: (A) findings requiring both changes in surgical strategy and post-operative evaluation/treatment; (B) findings requiring changes in surgical strategy, but not requiring a specific post-operative evaluation/treatment; (C) findings not requiring changes in surgical strategy but requiring post-operative evaluation/treatment.

Results and discussion: 500 charts were reviewed. 93 patients (18.6%) had significant cardiovascular and extra-cardiovascular findings from which 33.33% were in group A (6.2% of all patients), 7.5% (1.4% of all patients) were in group B, and 59.14% (11% of all patients) were in group C (Figure 1). Change in surgical strategies included performing lung, carotid, thyroid and other surgeries as an additional procedure to the cardiac operation, and switching from planned on-pump to off-pump CABG.

Conclusion: Routine preoperative NCCCT and CD evaluation in all non-urgent patients scheduled for cardiac surgery is an effective measure for uncovering cardiac and extra-cardiac findings prior to surgery. The results may consequently change surgical approaches and/or post-operative follow-ups and treatments, which may decrease morbidity and mortality rates during surgery, immediately after, or in the long term post-operative period.