Does routine preoperative computed tomography imaging provide clinical utility in patients undergoing primary cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients undergoing primary cardiac surgery, does routine preoperative computed tomography (CT) imaging provide clinical benefit as measured by either a decrease in complications or a change in surgical approach. Altogether, 125 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 studies reviewed reported change in operative strategy as a result of preoperative imaging, with the most common change being an alternative cannulation site. Two comparative studies reported decreased mortality and decreased perioperative stroke in patients who undergo preoperative CT, when compared to patients who do not. However, the results from these 2 studies are difficult to interpret as they used different imaging modalities and different patient populations. One study selected high-risk patients for preoperative CT, rather than routine use, but the findings were similar. We conclude that preoperative CT, whether non-contrast CT or CT angiography, can help optimize operative strategy and decrease postoperative stroke rate and mortality after primary cardiac surgery.