Introduction - Cardiac complications are reported to affect one fourth of patients submitted to thoracoabdominal aortic aneurysm (TAAA) open repair1. Current guidelines do not consider the use of routine coronary computed tomography (CCT) in the setting of preoperative risk stratification. Aim of this study is to compare the efficacy of selective versus routine use of CCT in preventing perioperative cardiac complications following open TAAA repair. Methods - Data of 510 patients submitted to elective open TAAA repair at our Centre between 2009 and 2017 were retrospectively analyzed. Patients operated before March 2015 (Group 1, n = 327) underwent selective preoperative CCT according to the European Society of Cardiology recommendations for non-invasive imaging stress testing before surgery in asymptomatic patients2. Patients operated from March 2015 (Group 2, n = 183) underwent routine preoperative CCT, except when contraindicated or considered redundant. CCT acquisition and interpretation was performed following a standard published protocol3, and was associated with concurrent thoraco-abdominal aortic CT assessment when necessary. Pre-, intra-, and post-operative data were compared in the two groups by using Fisher Exact test or Student t test. Specific considered clinical endpoints included: 30-day mortality, composite major adverse events (MAE) rate (death, paraplegia, renal failure requiring dyalisis, myocardial infarction), composite cardiac complications rate (arrhythmias, cardiac failure, pericardial effusion, acute myocardial infarction), and acute myocardial infarction rate. Results - Groups were similar in terms of demographics, except for gender (females: 26% in Group 1 vs 35% in Group 2; P = .04). No significant differences were found in preoperative risk factors and aneurysm etiology or extent. Preoperative CCT was performed in 43 patients in Group 1 (13%), and 150 patients in Group 2 (82%). At least one critical coronary lesion was identified in 9 patients in Group 1 and in 33 patients in Group 2 (2.7% vs 18%, P < .0001). The rate of identification of critical coronary lesions in scanned patients was similar in the two groups (21% vs 22%, respectively; P = 1.0). Following CCT results, 2 patients in Group 1, and 13 patients in Group 2 underwent surgical or endovascular myocardial revascularization before TAAA repair. Perioperative clinical outcome of TAAA open repair was similar in Group 1 and Group 2 (30-day mortality 6% vs 9%, P = .374; composite MAE 12% vs 13%, P = .890; composite cardiac complications 20% vs 21%, P = .821; acute myocardial infarction 3% vs 3%, P = 1.0, respectively). Conclusion - Routine use of preoperative CCT before TAAA open repair allows detecting a significant number of critical coronary lesions. However, this approach is not associated with a significant reduction in the rate of perioperative death, MAEs and cardiac complications. References1Coselli JS, LeMaire SA, Preventza O, de la Cruz KI, Cooley DA, Price MD, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016 May;151(5):1323-37.2Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014 Sep 14;35(35):2383-4313Chieffo A, Giustino G, Spagnolo P, Panoulas VF, Montorfano M, Latib A, et al. Routine Screening of Coronary Artery Disease With Computed Tomographic Coronary Angiography in Place of Invasive Coronary Angiography in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv. 2015 Jul;8(7):e002025.