Incidental thoracic findings in computed tomography scans before transcatheter aortic valve implantation. (30th October 2018)

• Record Type: Journal Article
• Authors: Markowiak, Till; Holzamer, Andreas; Hilker, Michael; Pregler, Benedikt; Debl, Kurt; Hofmann, Hans-Stefan; Ried, Michael
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 28:Number 4(2019)
• Page Start: 559
• Page End: 565
• Publication Date: 2018-10-30
• Subjects: Transcatheter aortic valve implantation -- Lung cancer -- Solitary pulmonary nodule -- Thoracic lymphadenopathy; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivy299
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Preoperative computed tomography (CT) scans for transcatheter aortic valve implantation (TAVI) are used routinely. In elderly high-risk patients, incidental radiographic findings are frequently reported. The aim of this study was to investigate the impact of auxiliary findings on the patients' mid-term survival, which might affect the treatment strategy. METHODS: Between March 2011 and April 2016, all radiological reports of contrast-enhanced CT scans of 976 patients scheduled for TAVI were analysed retrospectively for incidental thoracic findings including solitary pulmonary nodules (SPN) and thoracic lymphadenopathy (LAP). The minimum follow-up period was 1 year after TAVI. RESULTS: The median age of all patients was 79 years; 51.9% ( n = 507) were women. Approximately 37% ( n = 361) of patients showed 1 of the determined findings. An SPN ≥5 mm was diagnosed in 16.4% ( n = 160) of patients. Four of them developed lung cancer and 2 nodules were identified as metastases during follow-up. In addition, 12% ( n = 117) of the patients had thoracic LAP. Whereas SPN had no significant effect on the overall survival rate, evidence of LAP turned out to be a statistically significant factor regarding 4-year survival ( P = 0.001; hazard ratio 1.66; 95% confidence internal 1.19–2.31). CONCLUSIONS: SPN ≥5 mm were detected in 16.4% of patients scheduled for TAVI. Nevertheless, the incidence of lung cancer was low and the effect on survival in this high-risk group of patients was statistically not significant. In contrast, thoracic LAP had a significant negative effect on survival. It needs to be proven if the outcome of this cohort can be enhanced by further diagnostics and therapy.