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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Kulkarni S, Szeto WY, Jha S. Preoperative Computed Tomography in the Adult Cardiac Surgery Patient. [Review]. Current Problems in Diagnostic Radiology. 51(1):121-129, 2022 Jan-Feb. Review/Other-Dx N/A To review both open and minimally invasive procedures and the common complications which arise following cardiac surgery. No results stated in the abstract. 4
2. Valente T, Bocchini G, Rossi G, Sica G, Davison H, Scaglione M. MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report. [Review]. British Journal of Radiology. 92(1101):20170980, 2019 Sep. Review/Other-Dx N/A To summarize our experience with multidetector CT (MDCT) in the preoperative evaluation of the re-operative cardiac surgery patient and at the same time we resume literature data about the subject in question. Aims of this paper are to highlight the findings that the radiologist should know, to stress the relevance of a multidisciplinary approach in order to plan a patient-tailored operative strategy and to demonstrate the effectiveness of this integrated approach in terms of surgical outcomes. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance, pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings.Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications. 4
3. Bang TJ, Chung JH, Walker CM, et al. ACR Appropriateness Criteria® Routine Chest Imaging. J Am Coll Radiol 2023;20:S224-S33. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for routine chest imaging. No results stated in abstract. 4
4. Beache GM, Mohammed TH, Hurwitz Koweek LM, et al. ACR Appropriateness Criteria R Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. Journal of the American College of Radiology. 17(11S):S346-S354, 2020 Nov.J. Am. Coll. Radiol.. 17(11S):S346-S354, 2020 Nov. Review/Other-Tx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute nonspecific chest pain-low probability of coronary artery disease. No results stated in abstract. 4
5. Litmanovich D, Hurwitz Koweek LM, Ghoshhajra BB, et al. ACR Appropriateness Criteria R Chronic Chest Pain-High Probability of Coronary Artery Disease: 2021 Update. Journal of the American College of Radiology. 19(5S):S1-S18, 2022 05.J. Am. Coll. Radiol.. 19(5S):S1-S18, 2022 05. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic chest pain-high probability of coronary artery disease. No results stated in abstract. 4
6. Shah AB, Kirsch J, Bolen MA, et al. ACR Appropriateness Criteria R Chronic Chest Pain-Noncardiac Etiology Unlikely-Low to Intermediate Probability of Coronary Artery Disease. Journal of the American College of Radiology. 15(11S):S283-S290, 2018 Nov.J. Am. Coll. Radiol.. 15(11S):S283-S290, 2018 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic chest pain, noncardiac etiology unlikely, low to intermediate probability of coronary artery disease. No results stated in abstract. 4
7. Stojanovska J, Hurwitz Koweek LM, Chung JH, et al. ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury. J Am Coll Radiol 2020;17:S380-S90. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for blunt chest trauma, suspected cardiac injury. No results stated in abstract. 4
8. Krishnamurthy R, Suman G, Chan SS, et al. ACR Appropriateness Criteria® Congenital or Acquired Heart Disease. J Am Coll Radiol 2023;20:S351-S81. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for congenital or acquired heart disease. No results stated in abstract. 4
9. Bolen MA, Bin Saeedan MN, Rajiah P, et al. ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update. J Am Coll Radiol 2022;19:S37-S52. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for dyspnea-suspected cardiac origin (ischemia already excluded). No results stated in abstract. 4
10. Malik SB, Hsu JY, et al. ACR Appropriateness Criteria® Infective Endocarditis. J Am Coll Radiol. 2021 May;18(5S):S1546-1440(21)00029-6. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for infective endocarditis. No results stated in abstract. 4
11. Kicska GA, Hurwitz Koweek LM, Ghoshhajra BB, et al. ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome. J Am Coll Radiol 2021;18:S474-S81. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected acute aortic syndrome. No results stated in abstract. 4
12. Parenti VG, Vijay K, Maroules CD, et al. ACR Appropriateness Criteria® Workup of Noncerebral Systemic Arterial Embolic Source. J Am Coll Radiol 2023;20:S285-S300. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for workup of noncerebral systemic arterial embolic source. No results stated in abstract. 4
13. de Groot PM, Chung JH, Ackman JB, et al. ACR Appropriateness Criteria® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2019;16:S184-S95. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for noninvasive clinical staging of primary lung cancer. No results stated in abstract. 4
14. Ackman JB, Chung JH, Walker CM, et al. ACR Appropriateness Criteria® Imaging of Mediastinal Masses. J Am Coll Radiol 2021;18:S37-S51. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging of mediastinal masses. No results stated in abstract. 4
15. Raptis CA, Goldstein A, Henry TS, et al. ACR Appropriateness Criteria® Staging and Follow-Up of Esophageal Cancer. J Am Coll Radiol 2022;19:S462-S72. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for staging and follow-up of esophageal cancer. No results stated in abstract. 4
16. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024;150:e351-e442. Review/Other-Dx N/A Recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. No results stated in abstract. 4
17. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
18. Garcia MJ, Kwong RY, Scherrer-Crosbie M, et al. State of the Art: Imaging for Myocardial Viability: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2020;13:e000053. Review/Other-Dx N/A Imaging for myocardial viability. No results stated in abstract. 4
19. den Harder AM, de Heer LM, Meijer RC, et al. Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke. [Review]. European Journal of Radiology. 85(4):744-50, 2016 Apr. Review/Other-Dx 18 studies To investigate whether preoperative chest computed tomography (CT) decreases postoperative mortality and stroke rate in cardiac surgery by detection of calcifications and visualization of postoperative anatomy in redo cardiac surgery which can be used to optimize the surgical approach. Eighteen studies were included (n=4057 patients) in which 2584 patients received a preoperative CT. Seven articles (n=1754 patients) concerned primary surgery and eleven articles (n=2303 patients) concerned redo cardiac surgery. None of the studies was randomized but 8 studies provided a comparison to a control group. Stroke rate decreased with 77-96% (primary surgery) and 18-100% (redo surgery) in patients receiving a preoperative CT. Mortality decreased up to 66% in studies investigating primary surgery while the effect on mortality in redo surgery varied widely. Change in surgical approach based on CT-findings consisted of choosing a different cannulation site, opting for off-pump surgery and cancellation of surgery. 4
20. Grocott HP, Tran T. Aortic atheroma and adverse cerebral outcome: risk, diagnosis, and management options. Seminars in Cardiothoracic & Vascular Anesthesia. 14(2):86-94, 2010 Jun. Review/Other-Dx N/A To help understand the risk relationships, diagnostic modalities, and potential therapy interventions which allows the integration of information aimed atoptimizing perioperative care of the patient undergoing cardiac surgery. No results stated in the abstract. 4
21. Nishi H, Mitsuno M, Tanaka H, Ryomoto M, Fukui S, Miyamoto Y. Who needs preoperative routine chest computed tomography for prevention of stroke in cardiac surgery?. Interactive Cardiovascular & Thoracic Surgery. 11(1):30-3, 2010 Jul. Observational-Dx 300 patients The purpose of this study was to clarify the role of preoperative routine chest computed tomography (CT) for prevention of stroke and to determine the prevalence of ascending aortic calcification in patients undergoing cardiac surgery. Three hundred consecutive patients who underwent elective cardiac operations excluding thoracic aortic surgery had preoperative non-contrast CT. Thirteen patients (4.3%) had severe calcification in the ascending aorta which required alteration of the cannulation site. Univariate analysis showed preoperative renal dysfunction, dialysis and aortic stenosis as predictors for ascending aortic calcification, but not history of stroke, peripheral vascular disease, and age. In multivariate analysis, aortic stenosis was found as the only predictor. The prevalence of severe ascending aortic calcification was 11.9% (10/84) in patients with aortic stenosis. Stroke occurred in two (0.67%) of the patients in the entire group but none in the 13 patients with surgical modification. For patients with aortic stenosis or hemodialysis, a low postoperative stroke rate can be achieved in elective cardiac surgery by use of routine preoperative chest CT to identify patients with ascending aortic calcification who require modification of the surgical technique. 3
22. Albacker TB, Alhothali AM, Alhomeidan M, et al. Does preoperative screening with computed tomography of the chest decrease risk of stroke in patients undergoing coronary artery bypass grafting. Quant Imaging Med Surg 2023;13:2507-13. Review/Other-Dx 405 patients To determine the clinical impact and usefulness of routine use of plain chest computerised tomography to screen for aortic calcification on incidence of postoperative stroke in coronary artery bypass grafting (CABG) patients. Fourteen patients (3.5%) developed postoperative stroke. There was no difference in preoperative and operative characteristics between patients who developed postoperative stroke and those who did not, except for the history of preoperative stroke or transient ischemic attack (TIA) that was higher in the group who developed postoperative stroke (50.00% vs. 6.19%, P<0.001). Patients who developed postoperative stroke had higher percentage of aortic root calcification (78.57% vs. 64.18%), ascending aortic calcification (28.57% vs. 19.07%) and descending aortic calcification (85.71% vs. 73.71%) but none of them reached statistical significance. History of preoperative stroke or TIA was the only significant predictor of postoperative stroke using both univariate and multivariate regression models. 4
23. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;139:e698-e800. Review/Other-Dx N/A Guideline for the management of adults with congenital heart disease. No abstract available. 4
24. Fuss C, McCallum R, Ghoshhajra BB, et al. ACR Appropriateness Criteria® Evaluation of Coronary Artery Anomalies. J Am Coll Radiol 2025;22:S234-S42. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for coronary artery anomalies. No results stated in abstract. 4
25. Collet C, Onuma Y, Andreini D, et al. Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease. Eur Heart J. 39(41):3689-3698, 2018 Nov 01. Observational-Dx 223 patients To determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA (with and without FFRCT) or conventional angiography. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen’s kappa 0.82, 95% confidence interval 0.74–0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients. 3
26. Andreini D, Collet C, Leipsic J, et al. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EuroIntervention 2022;18:e872-e87. Review/Other-Dx N/A To review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions. No results stated in abstract. 4
27. den Harder AM, de Heer LM, de Jong PA, Suyker WJ, Leiner T, Budde RPJ. Frequency of abnormal findings on routine chest radiography before cardiac surgery. Journal of Thoracic & Cardiovascular Surgery. 155(5):2035-2040, 2018 05. Observational-Dx 1136 patients To  investigate the frequency of abnormal findings on a routine chest radiograph before cardiac surgery. One half of the patients (570/1136; 50%) had 1 or more abnormalities on the chest radiograph. Most frequent abnormalities were cardiomegaly, aortic elongation, signs of chronic obstructive pulmonary disease, vertebral fractures or height loss, possible pulmonary or mediastinal mass, pleural effusion, and atelectasis. In 2 patients (2/1136; 0.2%), the chest radiograph led to postponement of surgery, whereas in none of the patients the surgery was cancelled. In 1 patient (1/1136; 0.1%) the surgical approach was altered and in 15 patients (15/1136; 1.3%) further analysis was performed without having an impact on the planned surgical approach. 4
28. Marschall K, Kanchuger M, Kessler K, et al. Superiority of transesophageal echocardiography in detecting aortic arch atheromatous disease: identification of patients at increased risk of stroke during cardiac surgery. J Cardiothorac Vasc Anesth 1994;8:5-13. Observational-Dx 258 Transesophageal echocardiography (TEE) is useful in evaluating atheromatous disease of the aortic arch and that such disease is a risk factor for stroke in medical patients. Data obtained by traditional methods of evaluating the aortic arch prior to cardiac surgery, namely, chest x-ray (CXR) and cardiac catheterization (CATH), were compared with that detected by TEE. Images of the descending thoracic aorta and aortic arch seen on intraoperative TEE in 258 cardiac surgical patients were graded as I = normal, II = intimal thickening or plaques < 5 mm thick or with a mobile component (severe disease). The aortic knob seen on CXR in 209 of these patients was graded as normal, < 1/2 or > or = > 1/2 ring of calcification. Calcification in the aortic root (graded as 0, 1+, 2+) and irregularities in the aortic lumen seen at CATH in 33 patients were also examined. Data were analyzed with respect to age, gender, type of surgery, and stroke. Increasing age correlated strongly with increasing severity of aortic arch and descending thoracic aortic disease seen by TEE. Severe disease was not present in patients under age 50 but was present in about 20% of those over age 70. Atheromatous disease was found by TEE in 55% of patients with a normal CXR and 91% of those with heavily calcified aortic knobs. Ischemic strokes occurred in seven patients. Severe arch disease correlated significantly with stroke (P < .01). Other variables did not correlate with stroke. 3
29. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 2010;112:1084-96. Review/Other-Dx N/A Practice guidelines for perioperative transesophageal echocardiography. No abstract available. 4
30. Aviram G, Mohr R, Sharony R, Medalion B, Kramer A, Uretzky G. Open heart reoperations after coronary artery bypass grafting: the role of preoperative imaging with multidetector computed tomography. Israel Medical Association Journal: Imaj. 11(8):465-9, 2009 Aug. Observational-Dx 28 patients (CT group, 45 patients (no-CT group) To characterize patients who undergo computed tomography (CT) before repeat operations after previous coronary artery bypass grafting, and evaluate its benefit in terms of surgical outcome. The two groups were similar in most preoperative and operative characteristics. The CT group, however, included more patients with patent saphenous vein grafts and fewer with emergency operations, acute myocardial infarction and need for intraaortic balloon pump support. During mid-sternotomy, there was no injury to grafts in the CT group, while there were two patent grafts and three right ventricular injuries in the no-CT group. There was no significant difference in perioperative mortality (3.6% vs. 8.9%). The overall complication rate in the CT group was 21.4% compared to 42.2% in the no-CT group (P = 0.07). The only independent predictors of postoperative complications were diabetes mellitus, preoperative stroke and preoperative acute MI. 3
31. Goldstein MA, Roy SK, Hebsur S, et al. Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges. The International Journal of Cardiovascular Imaging. 29(3):709-17, 2013 Mar. Review/Other-Dx 364 patients This follow-up study aimed to examine the effects of routine preoperative cardiac imaging on patient’s length of stay as well as the overall hospital charges related to the index admission. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure. The primary clinical endpoint was the composite of perioperative death, myocardial infarction (MI), stroke, and hemorrhage-related reoperation. Secondary clinical endpoints included surgical procedural variables and the perioperative volume of bleeding and transfusion. Length of stay was determined using the hospital's electronic medical record. Cost data were extracted from the hospital's billing summary. Analysis was performed on individual categories of care, as well as on total hospital charges. Data were compared between subjects with and without MDCCTA, after adjustment for the Society of Thoracic Surgeons score. Baseline characteristics were similar between the two groups. MDCCTA was associated with shorter procedural times, shorter intensive care unit stays, fewer blood transfusions, and less frequent perioperative MI. There was additionally a trend towards a lower incidence of the primary endpoint (17.5 vs. 24.2 %, p = 0.13) primarily due to a lower incidence of perioperative MI (0 vs. 5.7 %, p = 0.002). MDCCTA was also associated with lower median recovery room [$1,325 (1,250-3,302) vs. $3,217 (1,325-5,353) p < 0.001] and nursing charges [$6,335 (3,623-10,478) vs. $6,916 (3,915-14,499) p = 0.03], although operating room charges were higher [$24,100 (22,300-29,700) vs. $23,500 (19,900-27,700) p < 0.05]. Median total charges [$127,000 (95,000-188,000) vs. $123,000 (86,800-226,000) p = 0.77] and length of stay [9 days (6-19) vs. 11 days (7-19), p = 0.21] were similar. Means analysis demonstrated a strong trend towards lower mean total hospital charges [$163,000 (108,426) vs. $192,000 (181,706), p = 0.06] in the MDCCTA group. In conclusion, preoperative MDCCTA is associated with a number of improved perioperative outcomes and does not significantly effect the length of stay or total hospital charges during the index hospitalization. 4
32. Imran Hamid U, Digney R, Soo L, Leung S, Graham AN. Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. European Journal of Cardio-Thoracic Surgery. 47(5):819-23, 2015 May. Observational-Dx 326 males, 218 females To determine the frequency of these injuries, associated outcome and if a preoperative computerized tomography (CT) scan reduces the risk of re-entry injury. The mean age was 61 years; 326 were male, 218 were female. Four hundred and eighty six patients underwent first time redo surgery, while 58 patients had multiple previous operations. The median logistic EuroSCORE was 11, in-hospital mortality rate was 9.5% and observed to expected mortality rate was 0.8. Re-entry complications occurred in 15 cases (2.7%). These included injuries to the aorta (n = 2), right atrium (n = 1), innominate vein (n = 2), internal mammary artery (n = 2), pulmonary artery (n = 2), lung parenchyma (n = 1), saphenous vein graft (n = 2), right ventricle (n = 2) and ventricular fibrillation (n = 1). The mortality rate in patients with re-entry injury was 26% (n = 4) compared with 9% (n = 48) in those without re-entry complications. Preoperative planning by CT scan was performed in 162 cases and adherence of vital structures to the sternum was found in 60 cases; the right ventricle, innominate vein and bypass grafts in 41, 11 and 8, respectively. The incidence rate of re-entry injury was 0.6% in these patients vs 3.6% in those who did not have a preoperative CT scan (P = 0.046). Peripheral arterial cannulation was carried out in 35 patients (6.4%) to establish cardiopulmonary bypass (CPB) prior to sternotomy, and there were no mediastinal injuries observed in these cases. Multivariate logistic regression analysis revealed re-entry injury as one of the independent predictors of in-hospital mortality (P = 0.039). 3
33. Kamdar AR, Meadows TA, Roselli EE, et al. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Annals of Thoracic Surgery. 85(4):1239-45, 2008 Apr. Observational-Dx 167 patients To determine if high-risk preoperative multidetector computed tomographic angiography (MDCTA) findings were associated with greater use of preventive surgical strategies during redo cardiac surgery in patients with prior coronary artery bypass grafts (CABG). 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. 3
34. Khan NU, Yonan N. Does preoperative computed tomography reduce the risks associated with re-do cardiac surgery?. [Review] [25 refs]. Interactive Cardiovascular & Thoracic Surgery. 9(1):119-23, 2009 Jul. Review/Other-Dx N/A To review what a best evidence topic is according to the structured protocol. The question addressed was whether preoperative computed tomography (CT) scan reduces the risk associated with re-do cardiac surgery. A Medline search revealed 412 papers, of which seven were deemed relevant to the topic. We conclude that preoperative CT angiography using ECG-gated multi-detector scan enables excellent anatomical details of heart, aorta and previous grafts, and highlights high-risk cases due to adherent grafts or ventricle or aortic atherosclerosis. This allows for better risk stratification and change of surgical strategy to reduce the potential risk in patients coming for re-do cardiac surgery. According to published reports, high-risk CT-scan findings in these patients caused clinicians to cancel surgery in up to 13% of cases, while preventive surgical strategies including non-midline approach, peripheral vascular exposure or establishing cardiopulmonary bypass prior to re-sternotomy have been reported in over two-thirds of patients with significant reduction in the operative risk. The risk of damage to vital structures, including previous grafts, heart or larger vessels is generally reported fewer than 10%, with evidence of significantly lower incidence of intra-operative injuries in patients who had prior CT-scans compared to those who did not. Hence, adequate preoperative imaging using ECG-gated multi-slice CT is essential for optimum planning of re-do cardiac surgery. 4
35. Lapar DJ, Ailawadi G, Irvine JN Jr, Lau CL, Kron IL, Kern JA. Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery. Interactive Cardiovascular & Thoracic Surgery. 12(6):919-23, 2011 Jun. Observational-Dx 373 patients The objectives of this study were to characterize the use of preoperative computed tomography (CT) imaging for reoperative cardiac surgery and to examine its role in improving postoperative patient outcomes. We sought to determine whether preoperative CT imaging reduces adverse outcomes and operative mortality for patients undergoing cardiac procedures following prior sternotomy. From July 2002 to February 2009, 373 patients underwent cardiac reoperations. Patients were stratified according to those with preoperative CT imaging (CT, n=140) and to those without preoperative CT imaging (NCT) (NCT, n=233). Preoperative risk, operative features, and postoperative outcomes were evaluated. Operative mortality for all cardiac reoperations was 7.5%. Patient risk factors were similar between CT and NCT groups. Preoperative imaging was more commonly performed for reoperative isolated valve operations (CT=70% vs. NCT=55.8%, P=0.01) but less commonly performed for reoperative isolated coronary artery bypass grafting (CABG) operations (14.3% vs. 22.7%, P=0.05). Postoperative renal failure, prolonged ventilation and operative mortality were similar between groups. Importantly, perioperative stroke occurred only within the NCT group (5.6% vs. 0.0%, P=0.003), and emergent operative status [odds ratio (OR): 6.45, confidence interval (CI): 1.15-36.10, P=0.03] as an independent multivariate predictor of perioperative stroke. Thus, preoperative CT imaging is associated with lower rates of perioperative stroke in patients undergoing cardiac reoperations by optimizing cannulation and aortic clamping strategies. Routine use of preoperative CT should be considered for patients undergoing cardiac operations following prior sternotomy. 3
36. Maluenda G, Goldstein MA, Lemesle G, et al. Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography. American Heart Journal. 159(2):301-6, 2010 Feb. Observational-Dx 364 patients To evaluate how the presurgical evaluation with multidetector computed tomographic angiography (MDCTA) impacts the outcomes after reoperative cardiac surgery (RCS). Baseline clinical characteristics were similar between the 2 groups. Individuals referred for MDCTA showed a trend toward a lower incidence of the composite primary end point (17.5% vs 24.2%, P = .13), primarily related to a significantly lower incidence of perioperative MI (0% vs 5.7%, P = .002). Multidetector computed tomographic angiography was also associated with shorter perfusion (90 vs 110 minutes, P = .002), cross clamp time (63 vs 75 minutes, P = .003), and total time in intensive care unit (103 vs 148 hours, P = .04), and a lower volume of postoperative RBC transfusion (627 vs 824 mL, P = .09). These differences remained significant after adjustment for the Society of Thoracic Surgeons score and the performing surgeon. 3
37. Nikolaou K, Vicol C, Vogt F, et al. Dual-Source computed tomography of the chest in the surgical planning of repeated cardiac surgery. Journal of Cardiovascular Surgery. 53(2):247-55, 2012 Apr. Observational-Dx 28 patients We sought to evaluate the contribution of dual-source multidetector-row computed tomography (DSCT) of the heart and thorax in planning repeated open heart surgery. DSCT findings led to a change of surgical approach for 9/28 (32.1%) patients (non-midline incision, N.=3; surgery performed under circulatory arrest, N.=5; peripheral arterial cannulation before sternotomy, N.=1) and cancellation of surgery for 4/28 (14.3%) patients (heavy aortic and coronary calcifications impeding bypass surgery, N.=2; right heart or aortic aneurysm in close proximity to the sternum in high risk patients, N.=2). The planned surgical approach remained unchanged after DSCT for the remaining15/28 (53.6%) patients. Of 54 bypass graft conduits (20 arterial, 34 venous) visualized on DSCT in 20 patients after previous bypass grafting, 16 arterial and 24 venous grafts were patent, while 4 arterial and 10 venous grafts were occluded. 3
38. Narayanan H, Viana FF, Smith JA, et al. Dynamic four-dimensional computed tomography (4D CT) imaging for re-entry risk assessment in re-do sternotomy - first experience. Heart, Lung & Circulation. 24(10):1011-9, 2015 Oct. Review/Other-Dx 19 patients To pioneer a study on utilisation of dynamic four-dimensional computed tomography (4D CT) for re-entry risk assessment in re-do sternotomy by determining the presence of tethering of the sternum to underlying structures. Overall, there was excellent correlation between preoperative imaging and intraoperative findings. The technique enabled our surgeons to meticulously plan the procedures and to avoid re-entry related injuries. 4
39. Choi AD, Brar V, Kancherla K, et al. Prospective Evaluation of Cardiac CT in Reoperative Cardiac Surgery. JACC Cardiovasc Imaging 2016;9:1356-57. Review/Other-Dx 80 To prospectively compare the accuracy of CT detection of retrosternal adhesions against the gold standard of intraoperative findings in patients with reoperativecardiac surgery. No abstract available. 4
40. Jones DA, Beirne AM, Kelham M, et al. Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial. Circulation 2023;148:1371-80. Observational-Dx 688 patients Randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, -23.5 to -18.4]; P<0.001), alongside improved mean ICA satisfaction scores (1=very good to 5=very poor; -1.1 difference [98.33% CI, -1.2 to -0.9]; P<0.001), and reduced incidence of contrast-induced nephropathy (3.4% versus 27.9%; odds ratio, 0.09 [98.33% CI, 0.04-0.2]; P<0.001). Procedural complications (2.3% versus 10.8%; odds ratio, 0.2 [95% CI, 0.1-0.4]; P<0.001) and 1-year major adverse cardiac events (16.0% versus 29.4%; hazard ratio, 0.4 [95% CI, 0.3-0.6]; P<0.001) were also lower in the CTCA+ICA group. 3
41. Yoshioka I, Saiki Y, Ichinose A, et al. Tagged cine magnetic resonance imaging with a finite element model can predict the severity of retrosternal adhesions prior to redo cardiac surgery. Journal of Thoracic & Cardiovascular Surgery. 137(4):957-62, 2009 Apr. Observational-Dx 13 patients The purpose of this investigation was to evaluate whether the severity of retrosternal adhesions can be accurately predicted by tagged cine magnetic resonance imaging. The preoperative adhesion severity score, as determined visually by tagged cine magnetic resonance imaging, was correlated with the intraoperative severity score (correlation coefficient: r = 0.76, P < .01). Mean strain at the surface of the heart, as calculated preoperatively by finite element model analysis, was inversely correlated with the intraoperative adhesion severity score (r = -0.78, P < .01). 2
42. Hedgire SS, Saboo SS, Galizia MS, et al. ACR Appropriateness Criteria® Preprocedural Planning for Transcatheter Aortic Valve Replacement: 2023 Update. J Am Coll Radiol 2023;20:S501-S12. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for preprocedural planning for transcatheter aortic valve replacement. No results stated in abstract. 4
43. Barreiro-Perez M, Caneiro-Queija B, Puga L, et al. Imaging in Transcatheter Mitral Valve Replacement: State-of-Art Review. J Clin Med 2021;10. Review/Other-Dx N/A To highlight the main considerations for TMVR planning from an imaging perspective; before, during, and after TMVR. No results stated in abstract. 4
44. Tomlinson S, Rivas CG, Agarwal V, Lebehn M, Hahn RT. Multimodality imaging for transcatheter tricuspid valve repair and replacement. Front Cardiovasc Med 2023;10:1171968. Review/Other-Dx N/A Protocols and methodology for multi-modality imaging assessment of the tricuspid valve and associated structures. No results stated in abstract. 4
45. Yang IY, Pogatchnik BP. Computed Tomography Planning for Transcatheter Tricuspid Valve Interventions. Semin Roentgenol 2024;59:87-102 Review/Other-Dx N/A Computed tomography planning for transcatheter tricuspid valve interventions. No abstract available. 4
46. Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Canadian Journal of Anaesthesia. 40(11):1022-7, 1993 Nov. Meta-analysis 21 reports Meta-analysis. To estimate the frequency with which routine postoperative CXR lead to clinically relevant new information. 0.1% of preoperative CXR caused modification of management. Concludes that in North American or European populations when a reliable history and a clinical examination are carried out, the cost of test is so high in relation to the clinical information provided that it is no longer justifiable. M
47. Yasukawa M, Taiji R, Marugami N, et al. Preoperative Detection of Pleural Adhesions Using Ultrasonography for Ipsilateral Secondary Thoracic Surgery Patients. Anticancer Research. 39(8):4249-4252, 2019 Aug. Observational-Dx 32 patients This study assessed the usefulness of preoperative ultrasonography to reduce the incidence of lung injury during the initial port insertion during video-assisted thoracic surgery (VATS). Seven adhesions were found at the VATS ports. Two of these adhesions were not evaluated as pleural adhesions using ultrasonography; however, they were loose. All initial ports were inserted without lung injury. There were no major complications. 4
48. Cassanelli N, Caroli G, Dolci G, et al. Accuracy of transthoracic ultrasound for the detection of pleural adhesions. Eur J Cardiothorac Surg 2012;42:813-8; discussion 18. Observational-Dx 220 patients The aim of this study was to assess the sensitivity and specificity of transthoracic ultrasound in the detection of pleural adhesions prior to thoracic surgery. A total of 1192 predictions were made. Ultrasound predictions were confirmed 1124 times and refuted 68 times. Sensitivity was 80.6% (95% confidence interval, 0.740-0.872) and specificity 96.1% (95% confidence interval, 0.949-0.973). The positive predictive value was 73.2% and the negative predictive value was 97.4%. 2
49. Wei B, Wang T, Jiang F, Wang H. Use of transthoracic ultrasound to predict pleural adhesions: a prospective blinded study. Thorac Cardiovasc Surg 2012;60:101-4. Observational-Dx 117 patients To assesses the characteristics of preoperative transthoracic ultrasound (TTU) evaluation of lung slide as a predictor of pleural adhesions below the primary intended trocar site on the chest wall. Pleural slide test using TTU had a sensitivity of 88.0 %, a specificity of 82.6 %, and an overall accuracy of 83.8 %. Kappa analysis yielded a significant degree of agreement between the radiologist's predictions and the intraoperative findings with regard to the identification of trocar sites free of pleural adhesions compared to sites with pleural adhesions (p < 0.05). 2
50. Measuring Sex, Gender Identity, and Sexual Orientation. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
51. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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