• Aarti R Patil, Allen Zheng, Yonathan Israel, Aanay Shah, Ahmed El-Eshmawi, Dimosthenis Pandis, Anelechi C Anyanwu, David H Adams, and Percy Boateng.
• Mount Sinai Health System, New York, NY. Electronic address: Aarti.patil@mountsinai.org.
• J. Thorac. Cardiovasc. Surg. 2025 Jan 19.

ObjectiveThe aim of this study was to assess the effectiveness of non-invasive 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 non-emergent mitral surgery and to assess any difference in adverse outcomes from this strategy.MethodsThis was a retrospective cohort study from a single center with data collected from July 2014 - 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 CT (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, post-operative 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 CT angiography group compared to the catheterization group.ResultsThe 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. 13 (3.8%) patients in the CTA group experienced a major adverse event compared to 25 (4.2%) patients in the ICA group. Of these, there were no mortalities in the CTA group but one (0.2%) operative mortality in the ICA group. Four (1.2%) patients in the CTA group had a post-operative stroke compared to three (0.5%) patients in the ICA group. One (0.3%) patient in the CTA group required renal replacement therapy postoperatively compared to 11 (1.8%) in the ICA group. Percutaneous coronary intervention was required in one (0.3%) patient in CTA group and 2 (0.3%) patients in ICA group for a coronary complication of valve surgery despite non-obstructive coronary anatomy being confirmed in both groups pre-operatively. The odds ratio for having a major adverse event when worked up by CTA compared to ICA was 0.904 (0.443, 1.761).ConclusionThere were no increased odds of experiencing a major adverse event for low risk mitral valve patients undergoing preoperative coronary evaluation with CTA compared to ICA. This data has modified our practice pattern where we now offer coronary CTA to all elective patients who are low risk for coronary artery disease.Copyright © 2025. Published by Elsevier Inc.

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