Possibilities of transesophageal echocardiography for assessing the volemic status of patients during direct myocardial revascularization operations on the beating heart: a review

Abstract

Introduction. Uncertainty about approaches to optimizing monitoring and tactics of hemodynamic correction today directly affects the effectiveness of interventions. This problem is especially pronounced in the case of patients with high cardiac risk, as well as in the case of rapidly developing intraoperative hemodynamic disorders, which are a specific feature of some cardiac surgical interventions, such as myocardial revascularization operations on a beating heart. In such a situation, the key factor for the success of the operation is the coordination of the work of the surgeon and the anesthesiologist. Objectives. To determine the main approaches to monitoring and assessing the volemic status of a patient during direct myocardial revascularization operations on a working heart and to evaluate the possibility of transesophageal echocardiography as such a monitoring tool. Materials and methods. The search was carried out in the electronic databases PubMed, Scopus, Web of Science Core Collection; the analysis was carried out based on works published in the period from 2001 to 2021. Results. The resulting material, which includes validated peer-reviewed studies, randomized clinical trials, major systematic reviews and meta-analyzes, provides an overview of global experience in optimizing fluid loading and its characteristics in cardiac surgery patients. According to the analyzed data, there is no consensus among specialists on the above issues, and many important factors remain outside the framework of everyday clinical practice. For high-quality interaction, a combination of highly informative monitoring and proven tactics of conducting perioperative infusion therapy in response to the dynamically changing condition of the patient is required. Conclusions. To develop unified criteria for hemodynamic correction in each individual situation, it is necessary to assess the volemic status in patients who undergo myocardial revascularization on a beating heart in real time. In this vein, transpesophageal echocardiography is presented by the authors as the tool of choice for optimizing monitoring during off-pump coronary artery bypass graft surgery.