Computed tomography follow-up after elective proximal aortic surgery: Less is more?

American Heart Journal, vol. 249, pp. 66–75

Abstract

STUDY OBJECTIVE: The added value of computed tomography (CT) follow-up after elective proximal aortic surgery is unclear. We evaluated the benefit of CT follow-up by assessing the incidence of aorta-related complications and reinterventions detected during routine CT follow-up. METHODS: Data on 314 patients undergoing first time elective proximal aortic surgery between 2000 and 2015 were collected. The primary study end points were aorta-related complications and reinterventions, detected during routine CT follow-up. Secondary study endpoints included all aorta-related complications and reinterventions, irrespective of the mode of detection and survival. RESULTS: Median CT follow-up time was 6.8 (IQR 4.1-9.8) years, during which a total of 1303 routine follow-up CT-scans (median 4, IQR 3-5) were performed. During CT follow-up, aorta-related complications were detected in 18 (5.7%) patients, of which 6 (1.6%) underwent reintervention. In total, 28 aorta-related complications were observed in 23 (7.3%) patients, of which 9 led to reintervention. In order to detect 1 aorta-related complication leading to reintervention, 218 routine follow-up CT-scans were required. The unadjusted and EuroSCORE II adjusted hazard ratios of not undergoing CT follow-up on mortality were 1.260 (95% CI 0.705-2.251) and 0.830 (95% CI 0.430-1.605), respectively. CONCLUSIONS: Following first time elective proximal aortic surgery, aorta-related complications are uncommon, are not always detected during CT follow-up and, if detected, often do not result in reintervention. Therefore, a more conservative CT follow-up protocol could be considered in selected patients to reduce lifetime radiation burden and health care costs.

Authors 7

1. Delano J. de Oliveira Marreiros corresponding Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: d.j.de_oliveira_marreiros@lumc.nl

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

2. Anton Tomšič Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

3. Thomas J. van Brakel Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

4. Jaap F. Hamming Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands

5. Arthur J.H.A. Scholte Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

6. Jesper Hjortnaes Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

7. Robert J.M. Klautz Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands