Koroner Arter Bypass Cerrahisinde İnsidental Bulguların Cerrahi Planlama Üzerindeki Klinik Etkisi

Öz

Amaç: Bu çalışmanın amacı, elektif izole koroner arter bypass greftleme (KABG) cerrahisi planlanan hastalarda, preoperatif dönemde uygulanan kontrastsız torakoabdominal bilgisayarlı tomografi (BT) ile saptanan insidentalomaların sıklığını belirlemek ve bu bulguların cerrahi planlama üzerindeki etkisini değerlendirmektir. Gereç ve Yöntem: Ocak 2021 – Aralık 2024 tarihleri arasında elektif KABG uygulanan 534 hasta retrospektif olarak incelendi. Tüm hastalara, rutin preoperatif değerlendirme protokolü kapsamında kontrastsız torakoabdominal BT çekildi. Saptanan insidentalomalar klinik anlamlılıklarına göre sınıflandırıldı. Cerrahi plan değişikliği olan hastalar Grup 1, değişiklik olmayanlar insidentaloma varlığına göre Grup 2 ve 3 olarak gruplandırıldı. Demografik veriler, intraoperatif ve postoperatif sonuçlar karşılaştırıldı. Bulgular: Hastaların %70.8’inde en az bir insidentaloma saptandı. Bu bulguların %12’si cerrahi planlamayı etkiledi. En sık değişiklik off-pump cerrahiye yönelim ve greft planlamasında oldu. Altı hastada operasyon iptal edilerek ileri merkeze yönlendirme yapıldı. Cerrahi plan değişikliği yapılan hastalar daha yaşlı ve sol ventrikül fonksiyonu daha düşük olan grubu oluşturuyordu. 30 günlük mortalite oranı gruplar arasında anlamlı fark göstermedi. Sonuç: Elektif KABG hastalarında preoperatif kontrastsız torakoabdominal BT, hem cerrahi planlamaya hem de sistemik taramaya katkı sağlayarak hasta güvenliğini artırmaktadır. Uygun maliyeti ve yaygın erişilebilirliği ile bu yaklaşım, klinik uygulamada değerli bir araç olabilir.

Anahtar Kelimeler

• Cerrahi planlama
• İnsidentaloma
• kontrastsız bilgisayarlı tomografi
• koroner arter bypass greftleme
• preoperatif değerlendirme

Clinical Impact of Incidental Findings on Surgical Planning in Coronary Artery Bypass Surgery

Öz

Objective: To determine the frequency of incidental findings detected by preoperative non-contrast thoracoabdominal computed tomography (CT) in patients undergoing elective isolated coronary artery bypass grafting (CABG) and to assess their impact on surgical planning. Material and Method: This retrospective study included 534 patients who underwent elective CABG between January 2021 and December 2024. As part of the routine preoperative assessment protocol, all patients received a non-contrast thoracoabdominal CT scan. Incidental findings were classified by clinical significance. Patients were grouped based on whether surgical planning was altered (Group 1), unchanged with incidental findings (Group 2), or unchanged without findings (Group 3). Demographic, intraoperative, and postoperative data were compared across groups. Results: At least one incidentaloma was detected in 70.8% of patients. Of these, 12% led to changes in surgical strategy, most commonly off-pump surgery or graft modification. Surgery was canceled in six patients due to high-risk findings. Group 1 patients were older and had lower left ventricular function. Thirty-day mortality did not differ significantly between groups. Conclusion: Preoperative non-contrast thoracoabdominal CT in elective CABG candidates contributes significantly to both surgical planning and systemic evaluation, enhancing patient safety. Given its accessibility and cost-effectiveness, this method represents a valuable tool in routine preoperative assessment.

Anahtar Kelimeler

• Coronary artery bypass grafting
• Incidentaloma
• non-contrast computed tomography
• preoperative evaluation
• surgical planning

Etik Beyan

Approval for the study was obtained from the Ethics Committee of Hitit University Faculty of Medicine on 12/03/2025. Decision no: 2025/54.

Kaynakça

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