Clinical Impact of Incidental Findings on Surgical Planning in Coronary Artery Bypass Surgery

Objective: To determine the frequency of incidental findings detected by preoperative non-contrast thoracoabdominal computed tomography (CT) in patients undergoing elective isolated coronary artery bypass grafting (CABG) and to assess their impact on surgical planning. Material and Method: This retrospective study included 534 patients who underwent elective CABG between January 2021 and December 2024. As part of the routine preoperative assessment protocol, all patients received a non-contrast thoracoabdominal CT scan. Incidental findings were classified by clinical significance. Patients were grouped based on whether surgical planning was altered (Group 1), unchanged with incidental findings (Group 2), or unchanged without findings (Group 3). Demographic, intraoperative, and postoperative data were compared across groups. Results: At least one incidentaloma was detected in 70.8% of patients. Of these, 12% led to changes in surgical strategy, most commonly off-pump surgery or graft modification. Surgery was canceled in six patients due to high-risk findings. Group 1 patients were older and had lower left ventricular function. Thirty-day mortality did not differ significantly between groups. Conclusion: Preoperative non-contrast thoracoabdominal CT in elective CABG candidates contributes significantly to both surgical planning and systemic evaluation, enhancing patient safety. Given its accessibility and cost-effectiveness, this method represents a valuable tool in routine preoperative assessment.