Research PresentationResearch PresentationSadia Shafi, MD April 2010

Can cardiac multidetector computed tomographic angiography help

predict outcomes in reoperative cardiac surgery?

BackgroundBackgroundReoperative cardiac surgery (RCS) carries a high mortality and morbidity due to increased technical difficulty as well as a higher prevalence and severity of CAD and comorbidities.

Background-continued Background-continued The main concern during surgical

reentry is the presence of cardiovascular structures behind the sternum, particularly:◦right ventricle◦aorta◦innominate vein ◦coronary bypass grafts

BackgroundBackgroundA method used to reduce

complications of RCS is the use of contrast enhanced multidetector computed tomographic angiography (MDCTA) before surgery

Using MDCTA deemed an “appropriate” indication based on expert consensus

The use of MDCTA before RCS was associated with--shorter ICU stays--less frequent perioperative MI--shorter perfusion and cross clamp time.

STS risk assessmentSTS risk assessmentis commonly used to predict

mortality and morbidities for patients undergoing cardiac surgery and RCS

into account many factors including type of surgery, age, gender, etc

Only cardiac function used in this assessment is Ejection Fraction

We are looking at whether other cardiac function parameters affect outcomes in redo surgery patients◦RV EF◦LA volume◦LV volume◦LV mass◦LV diastolic filling characteristics

MethodsMethodsRetrospective study of patients referred for

MDCTA before their RCS at the Washington Hospital Center between January 1, 2004 , and December 31, 2008

Data set with outcomes from previous studiesCT scans done before redo surgeries now

have limited views given radiation exposure, previously the entire cardiac function was recorded

End pointsEnd pointsThe primary end points

◦ peri-operative complications (myocardial infarction, stroke, and hemorrhage-related reoperation)

◦ operative death

The secondary end points will include ◦ intra-operative hemodynamic outcomes

(perfusion time, cross clamp time), ◦ total ICU time, ◦ the amount of peri-operative bleedings and RBC

transfusions, ◦ the rate of changes to the standard surgical

approach (including the use of a non-midline incision).

ReferencesReferences1. Maluenda G, Goldstein MA, Lemesle G, Weissman G., et

al. Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography. Am Heart Journal 2010; 159: 301-306.

2. Weintraub WS, Jones EL, Craver JM, et al. In-hospital and long-term outcome after reoperative coronary artery bypass graft surgery. Circulation 1995;92:1150-7

3. van Eck Frans M, Noyez L. Analysis of mortality within the first six months after coronary reoperation. Ann Thorac Surg 2002, 74:2106-2112.

4. van Eck FM, Noyez L, Verheugt FW, et al. Preoperative predication of early mortality in redocoronary artery surgery. Eur J Cardiothorac Surg 2002; 21:1031-6

5. Edwards FH, Clark RE, Schwartz M. Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience. Ann Thorac Surg 1994; 57: 12-9.

Thanks!Thanks!

Dr. Gaby WeissmanDr.Tony Fuisz Dr. Guy Weigold