The Effect of Routine Intraoperative Transesophageal Echocardiography on Surgical Management (original) (raw)
Related papers
Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2000
Purpose: To determine the relative impact of each category-based TEE indication according to the ASA guidelines. Methods: In 851 patients undergoing cardiac surgery, TEE clinical indications were classified as category I or II according to the ASA guidelines. Category I indications are patients in which TEE is considered useful and category II are those where TEE is potentially useful but indications are less clear. All TEE examinations were reviewed by two anesthesiologists with advanced training in TEE. For each patient, the clinical impact of TEE in the clinical management was assessed using five criteria: 1) change of medical therapy; 2) change in the surgical procedure; 3) confirmation of a suspected diagnosis; 4) positioning of an intravascular device, and 5) substitute to a pulmonary artery catheter (PAC).
The Annals of Thoracic Surgery, 2008
Backgound: The use of intraoperative transesophageal echocardiogram in patients with infective endocarditis is usually reserved for cases of inadequate preoperative testing or suspected extension to perivalvular tissue. Objectives: To explore the impact of routine intraoperative TEE in patients with infective endocarditis. Methods: The impact of intraoperative TEE on the operative plan, anatomic-physiologic results, and hemodynamic assessment or de-airing was analyzed in 59 patients (38 males, 21 females, mean age 57.7 ± 16.8 years, range 20-82) operated for active infective endocarditis over 56 months. Results: Immediate pre-pump echocardiography was available in 52 operations (86.7%), and changed the operative plan in 6 of them (11.5%). Immediate post-pump study was available in 59 patients (98.3%) and accounted for second pump-run in 6 (10.2%): perivalvular leak (3 cases), and immobilized leaflet, significant mitral regurgitation following vegetectomy, and failing right ventricle requiring addition of vein graft (1 case each). Prolonged de-airing was necessary in 6 patients (10.2%). In 5 patients (8.5%) the postoperative study aided in the evaluation and treatment of difficult weaning from the cardiopulmonary bypass pump. In 21 patients (35.6%) the application of intraoperative TEE affected at least one of the four pre-specified parameters. Conclusions: Intraoperative TEE has an important role in surgery for infective endocarditis and should be routinely implemented.
Journal of Perioperative Echocardiography, 2013
Transesophageal echocardiography (TEE) has become an important part of armamentarium for anesthesiologists in the management of patients undergoing cardiac surgery. Many studies have demonstrated the safety and utility of TEE in cardiac surgery. With advances in hardware and software, easy availability of resources for learning and optimal understanding of image generation and interpretation, many new findings crop up in the operating room (OR) which may have been missed in preoperative transthoracic echocardiography (TTE), leading to necessary changes in planned surgical procedure. In our retrospective analysis of 726 cases in which TEE was performed over the last 1 year, changes in decision was made in 65 (8.9%) of cases. This included 42 unanticipated findings prior to cardiopulmonary bypass and 23 new findings after CPB, requiring revision in 15 cases. With the increasing use and further impending advances of TEE, the number of cases in which surgical decision will be altered may increase in near future.
The Annals of Thoracic Surgery, 2016
Background. Although there have been several large reviews documenting the complications following intraoperative transesophageal echocardiography (TEE), most of these prior reports are almost 2 decades old and may not reflect current practices. The purpose of this study was to determine the incidence and types of complications following TEE in a contemporary cardiac surgical population. Methods. We conducted a retrospective analysis of all cardiac surgical patients having undergone an intraoperative TEE between April 1, 2004, and April 30, 2012. Patients with TEE-related complications were identified from our institutional cardiac surgical database to have their medical records manually reviewed through International Classification of Diseases-10th Revision coding for: 1) a priori defined complications including dysphagia, vocal cord and laryngeal injury, dysphonia, accidental puncture and laceration during a procedure, and hemorrhage and hematoma complicating a procedure; 2) the requirement for an in-hospital esophageal or bronchial endoscopy procedure; or 3) the requirement for postoperative specialist consultation from gastrointestinal bleed or other surgery services. A multivariable model was then developed to identify risk factors for TEE complications. Results. Of the 7,954 cardiac surgical cases performed during the study period, 1,074 had their records manually reviewed and 111 (1.4%) patients had possible complications. Multivariate analysis showed an increased risk of complications associated with age, body mass index, previous stroke, procedure other than isolated coronary artery bypass grafting, cardiopulmonary bypass time, and return to the operating room for any reason (model cstatistic [ 0.81). Conclusions. The overall incidence of TEE complications after cardiac surgery was 1.4%. Advanced age, low body mass index, complexity of procedure, prior stroke, prolonged bypass time, and return to the operating room appear to be significant risk factors for TEE complications.
Journal of Cardiothoracic and Vascular Anesthesia, 2000
To determine the usefulness of systematic intraoperative transesophageal echocardiography in a cardiac surgical unit. Design: Open prospective observational survey. Setting: University Hospital. Participants: Consecutive adult patients (n = 203) undergoing elective or urgent cardiac operations. Measurements and Main Results: Pre-cardiopulmonary bypass imaging yielded unsuspected findings in 26 patients (12.8%) and changed the planned surgery in 22 patients (10.8%). Transesophageal echocardiography modified the diagnosis in eight patients (17%) operated on for mitral valvulopathy, in seven patients (15.5%) with aortic valvular disease, in four patients (4.6%) with coronary artery disease, in five patients operated on for thoracic aorta diseases regardless of their localization (18.5%), and in two miscellaneous cases. On the basis of the data obtained from the transesophageal echocardiography carried out at the end of cardiopulmonary bypass, an immediate reintervention was required in five cases (2.5%). Conclusions: It is concluded that systematic intraoperative transesophageal echocardiography significantly affected decision making in this cardiac surgical unit. Its routine use in all cardiac surgical patients is recommended,
Practice Guidelines for Perioperative Transesophageal Echocardiography
Anesthesiology, 2010
P RACTICE Guidelines are systematically developed recommendations that assist the practitioner and the patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data. This update includes data published since the Practice Guidelines for Perioperative Transesophageal Echocardiography were adopted by the ASA and the Society of Cardiovascular Anesthesiologists in 1995 and published in 1996. 1 Methodology Definition of Perioperative Transesophageal Echocardiography For these Guidelines, perioperative transesophageal echocardiography (TEE) refers to TEE performed on surgical patients before, during, or immediately after surgery, including the critical care setting. Evidence of effectiveness is discussed relative to specific settings where perioperative TEE is customarily used (e.g., cardiac surgery, noncardiac surgery, and critical care). Purposes of the Guidelines The purposes of these Guidelines are (1) to assist the physician in determining the appropriate application of TEE and (2) to improve the outcomes of surgical patients by defining the utility of perioperative TEE based on the strength of supporting evidence. Focus These Guidelines focus on the application of TEE in surgical patients and potential surgical patients in the setting of cardiac surgery, noncardiac surgery, and postoperative critical care. The Guidelines do not apply to the assessment of nonsurgical patients or to postdischarge follow-up assessment of surgical patients. The Task Force believes that physician proficiency in the use of perioperative TEE is of paramount importance due to the risk of adverse outcomes resulting from incorrect interpretation. The Guidelines do not address training, certification, credentialing, and quality assurance, which are addressed elsewhere. 2-5 Application These Guidelines are intended for anesthesiologists and other physicians (e.g., cardiologists, surgeons, and intensivists) who use TEE in the perioperative setting. Recommendations to perform TEE are not applicable when the proce
Intraoperative Echocardiography: Support for Decision Making in Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, 2004
decision-making, and for assessment in difficult case scenarios (Table 1). The SCA/ASE guidelines defined perioperative echocardiography as TEE, epicardial echocardiography, and epiaortic ultrasonography performed in surgical patients before, during, or after the operation. 8 When we refer to a particular TEE view, the nomenclature and standard views as recommended by the SCA/ASE task force 7 will be used.