Joao Lima

Publication Detail

The publication detail shows the title, authors (with indicators showing other profiled authors), information on the publishing organization, abstract and a link to the article in PubMed. This abstract is what is used to create the fingerprint of the publication. If any grants are referenced by the publication, they will be listed here as well.

Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery.

Apur R Kamdar; Telly A Meadows; Eric E Roselli; Eiran Z Gorodeski; Ronan J Curtin; Joseph F Sabik; Paul Schoenhagen; Richard D White; Bruce W Lytle; Scott D Flamm; et al. (Profiled Author: Milind Desai)

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
The Annals of thoracic surgery 2008;85(4):1239-45.

BACKGROUND: Redo cardiothoracic surgery is associated with increased morbidity and mortality compared with primary operations. Multidetector computed tomographic angiography (MDCTA) delineates the course of previous coronary artery bypass grafts (CABG) and proximity of mediastinal structures to the chest wall. We sought to determine if high-risk preoperative MDCTA findings were associated with greater use of preventive surgical strategies during redo cardiac surgery in patients with prior CABG. METHODS: We studied 167 patients (mean age 69 +/- 9 years, 79% men) with prior CABG, referred for redo cardiac surgery, who underwent contrast-enhanced MDCTA to assess CABG location and mediastinal relationship to chest wall. Preoperative risk was determined. Prevalence of high-risk MDCTA findings, use of preventive surgical strategies, frequency of severe intraoperative bleeding, and postoperative mortality were recorded. RESULTS: Mean risk score was high (7.5 +/- 3). High-risk MDCTA findings included proximity (<1 cm) of right ventricle/aorta to chest wall (24%) or CABG crossing midline in close proximity (<1 cm anteroposteriorly) to sternum (38%). Preventive surgical strategies included surgery cancelled (4%), nonmidline incision (8%), deep hypothermic circulatory arrest (5%), initiation of peripheral cardiopulmonary bypass (11%) and extrathoracic vascular exposure before incision (53%). These strategies were used at a higher frequency in patients with high-risk MDCTA findings versus those without (88% versus 28%, p < 0.0001). Frequency of severe bleeding, graft injuries, and 1-month mortality were 4.4%, 5%, and 2.5%, respectively. CONCLUSIONS: Routine use of preoperative MDCTA to detect high-risk findings has a strong association with adoption of preventive surgical strategies in high-risk patients undergoing redo cardiac surgery.

Scientific Context

This section shows information related to the publication - computed using the fingerprint of the publication - including related publications, related experts and related grants with fingerprints representing significant amounts of overlap between their fingerprint and this publication. The red dots indicate whether those experts or terms appear within the publication, thereby showing potential and actual connections.