Who needs preoperative routine chest computed tomography for prevention of stroke in cardiac surgery?

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.