黑暗中总有一线光明:COVID-19胸部ct筛查可以防止不必要的心脏手术。

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Surgery Pub Date : 2022-10-01 Epub Date: 2022-06-22 DOI:10.23736/S0021-9509.22.12278-0
Fabrizio Rosati, Massimo Baudo, Giuseppe D'Ancona, Cesare Tomasi, Francesca Zanin, Besart Cuko, Lorenzo DI Bacco, Andrea Borghesi, Marco Zoppetti, Claudio Muneretto, Stefano Benussi
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引用次数: 0

摘要

背景:未增强胸部CT可以识别导致治疗策略改变的偶发症状。我们报告了我们在COVID-19大流行期间将常规胸部ct作为术前筛查工具的机构经验,重点是if的影响。方法:所有计划于2020年5月1日至12月31日进行心脏手术的患者,根据COVID-19大流行机构方案,术前行胸部ct平扫。我们分析了IFs的发生率,报告了手术后的改变,并确定了IFs的临床决定因素。结果:共纳入447例患者278例。IFs发生率为7.2%(20/278):实性肿块(11/ 20,55%)、淋巴细胞增殖性疾病(1/ 20,5%)、SARS-CoV-2肺炎(2/ 20,10%)、肺动脉慢性血栓栓塞(1/ 20,5%)、血管解剖异常(2/ 20,10%)、大裂孔疝(1/ 20,5%)、二尖瓣环钙化(1/ 20,5%)和瓷主动脉(1/ 20,5%)。根据IFs, 4例(20%-4/278,1.4%)患者未手术,8例(40%-8/278,2.9%)患者的手术与原计划不同,8例(40%-8/278,2.9%)患者在进行计划手术前需要进一步的术前检查。在单因素回归中,冠状动脉疾病、心房颤动和癌症史在出现明显IFs的患者中更为常见。恶性肿瘤病史被认为是胸部ct诊断显著IFs的唯一独立决定因素(OR=4.27 IQR: [1.14-14.58], P=0.0227)。结论:未增强胸部ct作为心脏手术术前筛查工具,可以偶然发现重要的临床表现,甚至可以取消手术。恶性肿瘤病史是CT偶然发现的决定因素,可以为高危患者提供量身定制的筛查方法。
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Every cloud has a silver lining: COVID-19 chest-CT screening prevents unnecessary cardiac surgery.

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.

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来源期刊
CiteScore
2.50
自引率
7.10%
发文量
204
审稿时长
4-8 weeks
期刊介绍: The Journal of Cardiovascular Surgery publishes scientific papers on cardiac, thoracic and vascular surgery. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, therapeutical notes, special articles and letters to the Editor. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (www.icmje.org). Articles not conforming to international standards will not be considered for acceptance.
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