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The Journal of Cardiovascular Surgery 2022 October;63(5):606-13

DOI: 10.23736/S0021-9509.22.12278-0


lingua: Inglese

Every cloud has a silver lining: COVID-19 chest-CT screening prevents unnecessary cardiac surgery

Fabrizio ROSATI 1 , Massimo BAUDO 1, Giuseppe D’ANCONA 2, Cesare TOMASI 1, Francesca ZANIN 1, Besart CUKO 1, Lorenzo DI BACCO 1, Andrea BORGHESI 3, Marco ZOPPETTI 3, Claudio MUNERETTO 1, Stefano BENUSSI 1

1 Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy; 2 Department of Cardiovascular Research, Vivantes Klinikum Urban, Berlin, Germany; 3 Operative Unit of 2nd Diagnostic Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy

BACKGROUND: Unenhanced chest CT can identify incidental findings (IFs) leading to management strategy change. We report our institutional experience with routine chest-CT as preoperative screening tool during the COVID-19 pandemic, focusing on the impact of IFs.
METHODS: All patients scheduled for cardiac surgery from May 1st to December 31st 2020, underwent preoperative unenhanced chest-CT according to COVID-19 pandemic institutional protocol. We have analyzed IFs incidence, reported consequent operative changes, and identified IFs clinical determinants.
RESULTS: Out of 447, 278 patients were included. IFs rate was 7.2% (20/278): a solid mass (11/20, 55%), lymphoproliferative disease (1/20, 5%), SARS-CoV-2 pneumonia (2/20, 10%), pulmonary artery chronic thromboembolism (1/20, 5%), anomalous vessel anatomy (2/20, 10%), voluminous hiatal hernia (1/20, 5%), mitral annulus calcification (1/20, 5%), and porcelain aorta (1/20, 5%) were reported. Based on IFs, 4 patients (20%-4/278, 1.4%) were not operated, 8 (40%-8/278, 2.9%) underwent a procedure different from the one originally planned one, and 8 (40%-8/278, 2.9%) needed additional preoperative investigations before undergoing the planned surgery. At univariate regression, coronary artery disease, atrial fibrillation, and history of cancer were significantly more often present in patients presenting with significant IFs. History of malignancy was identified as the only independent determinant of significant IFs at chest-CT (OR=4.27 IQR: [1.14-14.58], P=0.0227).
CONCLUSIONS: Unenhanced chest-CT as a preoperative screening tool in cardiac surgery led to incidental detection of significant clinical findings, which justified even procedures cancellation. Malignancy history is a determinant for CT incidental findings and could support a tailored screening approach for high-risk patients.

KEY WORDS: Diagnostic imaging; Thorax; Cardiac surgical procedures; COVID-19

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