Computed tomography coronary angiography as an alternative to invasive coronary angiography in preoperative evaluation for mitral surgery

Objective: To assess the effectiveness of noninvasive coronary computed tomography angiography (CTA) as an alternative to traditional invasive coronary angiography (ICA) for preoperative evaluation of low-risk patients with an indication for nonemergent mitral surgery and to assess any difference in adverse outcomes from this strategy. Methods: This was a retrospective cohort study from a single center with data collected from July 2014 to June 2020 for 1576 patients undergoing mitral valve surgery of all etiologies, excluding patients requiring coronary artery bypass surgery. We performed a 1:2 propensity score matching for patients evaluated with CTA (n = 345) to those evaluated with ICA (n = 602). The primary outcome was a composite of major adverse events in the immediate postoperative period, including death, stroke, new-onset renal failure, postoperative cardiac arrest, need for unplanned coronary artery bypass grafting or percutaneous coronary re-vascularization. The odds ratio was calculated for occurrence of major adverse events in the CTA group compared with the catheterization group. Results: The mean age (standard deviation) was 55.62 years (11.54) for the CTA group and 58.22 years (10.11) for the ICA group. In the CTA group 334 (96.8%) and from the ICA group 582 (96.7%) patients underwent mitral valve repair. Thirteen (3.8%) patients in the CTA group experienced a major adverse event compared with 25 (4.2%) patients in the ICA group. Of these, there were no mortalities in the CTA group but 1 (0.2%) operative mortality in the ICA group. Four (1.2%) patients in the CTA group had a postoperative stroke compared with 3 (0.5%) patients in the ICA group. One (0.3%) patient in the CTA group required renal-replacement therapy postoperatively compared with 11 (1.8%) in the ICA group. Percutaneous coronary intervention was required in 1 (0.3%) patient in CTA group and 2 (0.3%) patients in ICA group for a coronary complication of valve surgery despite nonobstructive coronary anatomy being confirmed in both groups preoperatively. The odds ratio for having a major adverse event when worked up by CTA compared with ICA was 0.904 (0.443, 1.761). Conclusions: There were no increased odds of experiencing a major adverse event for low-risk patients undergoing elective mitral valve surgery and preoperative coronary evaluation with CTA compared with ICA. These data have modified our practice pattern, where we now offer coronary CTA to all elective patients who are low risk for coronary artery disease.