Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis (original) (raw)
Related papers
The Effect of Routine Intraoperative Transesophageal Echocardiography on Surgical Management
Journal of Cardiothoracic and Vascular Anesthesia, 2007
Objective: To assess the effects of routine intraoperative transesophageal echocardiography (TEE) on surgical management of patients undergoing all types of cardiac surgery. Design: Prospective, observational. Setting: A single-institution, clinical investigation, university-affiliated hospital. Participants: Two hundred eighty-three consecutive patients undergoing cardiac surgery. Interventions: A comprehensive TEE examination was performed in every patient after the induction of anesthesia. An appropriate surgical plan was then developed. A focused TEE examination was also performed at the conclusion of surgery. Whether or not TEE findings represented new information and whether or not this new information altered surgical management was documented. Measurements and Main Results: There were 106 new TEE findings in 87 patients (31%). Half of the new findings involved the mitral valve, and a quarter involved the tricuspid valve. The new TEE information altered surgical management 77 ways in 71 patients (25%). Half of the altered surgical managements involved the mitral valve, and a third involved the tricuspid valve. In 8 patients (3%), TEE information influenced decisions regarding use/nonuse of cardiopulmonary bypass (CPB). In 2 patients, TEE examination after the separation from CPB prompted reinitiation of CPB. In 1 patient, TEE examination after the induction of general anesthesia prompted cancellation of surgery. Conclusions: The routine use of TEE during cardiac surgery revealed new cardiac pathology in 1 of every 3 patients and led to altered surgical management in 1 of every 4 patients. TEE information also influenced decisions regarding use/nonuse of CPB in 3% of patients. Thus, the authors suggest that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery.
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 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,
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 impact of intra-operative transoesophageal echocardiography on cardiac surgical practice
Anaesthesia, 2009
The use of transoesophageal echocardiography during cardiac surgery has increased dramatically and it is now widely accepted as a routine monitoring and diagnostic tool. A prospective study was carried out between September 2004 and September 2007, and included all patients in whom intra-operative echocardiography was performed, 2 473 (44%) out of a total of 5 591 cases. Changes to surgery were subdivided into predictable (where echocardiographic examination was planned specifically to guide surgery) and unpredictable (new pathology not diagnosed preoperatively). A change in the planned surgical procedure was documented in 312 (15%) cases. In 216 (69%) patients the changes were predictable and in 96 (31%) they were unpredictable. The number of predictable changes increased between 2004-5 and 2006-7 (8% vs 13%, p = 0.025). In these cases, intra-operative echocardiography was specifically requested by the surgeon to help determine the operative intervention. This has implications for consent and operative risk, which have yet to be fully determined.
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.
2010
Previous studies have shown that intraoperative transesophageal echocardiography provides important preoperative and postoperative information in various cardiac and noncardiac surgeries that may alter patient management and outcome. The role of intraoperative transesophageal echocardiography in patients in whom isolated coronary artery bypass graft surgery is anticipated has been reported only in small selected groups. This study was designed to prospectively evaluate the role of intraoperative transesophageal echocardiography in a large, nonselected group of patients undergoing primarily coronary artery bypass graft surgery.
HSR proceedings in intensive care & cardiovascular anesthesia, 2010
Intraoperative transesophageal echocardiography (iTEE) is widely accepted and routinely used during heart valve surgery. However, the impact of iTEE among patients undergoing coronary artery bypass grafting (CABG) is less well documented. In this study, we aim to define the impact of iTEE in patients undergoing myocardial revascularization for severe coronary artery disease. We analyzed clinical data and preoperative and intraoperative echocardiograms of all adults who underwent on pump coronary bypass and iTEE between January 2008 and December 2008. 521 patients (mean age 69±14 years) were studied. New prebypass findings were obtained in 82 (15.7%) patients: in 62 (11.9%) of these patients, this information changed the surgical plan. New postbypass findings were obtained in 8 patients (1.5%) and the surgical plan was altered in 4 patients (0.7%). Overall new findings were obtained in 90 patients (17.2%) and the surgical plan was altered in 66 patients (12.6%). These data support th...
The role of peri-operative transoesophageal echocardiography
SA Heart, 2017
More recent retrospective analyses of prospectively collected data suggest that around 5.6% of surgical procedures are altered on the basis of intra-operative echocardiographic findings and that there are cost-benefit savings particularly during combined valve and graft operations. (11,12,13) Recently, the roles for peri-operative echocardiography have also extended to include intensive care (14,15) and non-cardiac surgery. (16,17,18) Although it is complex to scientifically prove the benefits of a diagnostic monitor, TOE has been shown to strongly influence intra-operative anaesthetic decisions, particularly in patients with increased risk factors for haemodynamic instability or myocardial ischaemia. In a prospective observational case series of 98 patients undergoing abdominal surgery, the judgement of the anaesthetists was that TOE led to useful alterations in intraoperative care such as administration of fluids, vasoactive drugs and β blockers. In some patients, use of the pulmonary artery catheter was obviated. (19) Similarly, in another case series comprising 90 patients undergoing vascular, visceral and chest surgery, TOE directed changes in drug (47%) and fluid therapy (24%). (20)