Intraoperative Transoesophageal Echocardiography: Impact on Adult Cardiac Surgery

Abstract

Although multiple case reports have demonstrated the capability of transoesophageal echocardiography (TOE) to detect unsuspected cardiac pathology with important therapeutic implications, few studies have examined the effect of real-time interpretation of routine TOE on clinical management of a typical series of cardiac surgery patients. To assess the impact of intraoperative TOE on cardiac surgical management, we conducted a prospective observational study on 238 consecutive patients undergoing intraoperative TOE during adult cardiac surgery. Potentially important new diagnostic information was detected in 39 of 184 (21%) routine and in 53 of 54 requested TOE examinations, and led directly to different surgical procedures in 11 of 184 (6%) routine and in 12 of 54 (22%) requested TOE examinations. Our data suggests that intraoperative TOE may be a valuable tool in the routine management of adult cardiac surgical patients.

Impact of intraoperative transesophageal echocardiography in cardiac and thoracic aortic surgery: Experience in 1011 cases

“…Most of these patients did not need a return to CPB or an addi- tional graft, but needed observation for 20-30 min, when wall motion abnormalities resolved. A revision of the previously placed graft was required in two cases (0.6%) and this percentage was comparable to the data reported previously [7,9]. Thus to detect myocardial ischemia associated with possible graft kinking, coronary spasm or air embolism, IOTEE is desirable in the patient who is undergoing CABG.…”

“…We performed IOTEE on almost all patients who underwent CABG. The routine use of IOTEE during cardiac surgery remains controversial, especially for lower risk patients scheduled only for CABG [9]. Previous studies reported that revision of the graft was performed in 0.8% of patients who underwent CABG [7,10].…”

The impact of intra‐operative transoesophageal echocardiography on cardiac surgical practice

“…The ASE/SCA guidelines are frequently cited, and in this study the vast majority of studies (98%) were performed for category I and IIa indications. This approach may influence the results of the study because of the relatively few studies carried out in those patients where the fewest changes to surgical practice are expected, such as patients with preserved left ventricular function having isolated CABG [30]. Such a policy of selective TOE usage would be expected to minimise the number of complications (two out of 2 473 studies).…”

Initial Clinical Experience With a Miniaturized Transesophageal Echocardiography Probe in a Cardiac Intensive Care Unit

“…[2][3][4][5][6][7] In these patients, transesophageal echocardiography (TEE) can provide superior imaging although concerns exist regarding repeated or prolonged exposure to conventional TEE probe insertion. [8][9][10][11][12][13][14][15][16][17][18] Miniaturized TEE probes have been shown to be safe and to provide additional information to conventional monitoring, but further information regarding therapeutic impact is needed. [19][20][21][22][23] Initial reports of a recently introduced miniaturized, disposable, monoplane TEE probe (mTEE) with an approved insertion time of up to 72 hours (ClariTEE, ImaCor Inc., Garden City, NY) have been promising .…”