Real-time intraoperative transesophageal echocardiography-how useful? experience of 5,016 cases

Mishra, Manisha; Chauhan, Rajesh; Sharma, Krishan Kant; Dhar, Ajay; Bhise, Milind; Dhole, Sunil; Omar, Ashok; Kasliwal, Ravi R; Trehan, Naresh

doi:10.1016/s1053-0770(98)90232-4

Cited by 129 publications

(59 citation statements)

References 36 publications

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“…7 One recent study reported their experience with realtime intraoperative TEE in 5,016 patients. 8 The overall utility of TEE examinations for changing management in their study was 26.7% for CABG and 12.5% for valvular surgery. They did not, however, determine the relative impact of category-based TEE indications.…”

Section: Discussionmentioning

confidence: 91%

Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

Couture

Denault

McKenty

et al. 2000

Can J Anesth/J Can Anesth

100

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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).Results: TEE had greater utility in category I than in category II indications (15/53 (28%) vs 110/798 (14%) respectively) (P < 0.01). The nature of the clinical impact was as follows: modification of medical therapy in 67/125 (53%), modification of planned surgical intervention in 38/125 (30%), confirmation of a diagnosis in 34/125 (27%). The impact on therapy was higher in complex surgical procedures (39%) than in valvular replacement (19%) (P < 0.01) and coronary artery bypass surgery (10%) (P < 0.001).Conclusions: Our findings validate the usefulness of the ASA practice guidelines demonstrating a greater impact of TEE on clinical management for category I indications than for category II. TEE also had a greater clinical impact in complex surgical procedures and in valvular replacement.Objectif : Déterminer l'effet relatif de l'indication de l'ETO basée sur chacune des catégories relevant des recommandations ASA.Méthode : Chez 851 patients devant subir une intervention chirurgicale cardiaque, les indications cliniques de l'ETO ont été classées en catégorie I ou II selon les recommandations de l'ASA. Dans la catégorie I, ce sont les patients pour qui l'ETO est considérée utile et dans la catégorie II, ceux pour qui l'ETO est probablement utile, les indications n'étant pas aussi claires. Tous les examens d'ETO ont été révisés par deux anesthésiologistes de formation poussée en ETO. Les répercussions cliniques de l'ETO sur le traitement clinique de chaque patient ont été évaluées selon cinq critères: 1) la modification du traitement médical 2) un changement de technique chirurgicale 3) la confirmation d'un diagnostic présumé 4) la mise en place d'un appareil intravasculaire 5) un substitut au cathéter de l'artère pulmonaire (CAP).Résultats : L'ETO a présenté une plus grande utilité avec les indications de catégorie I qu'avec celles de caté-gorie II (15/53 (28 %) vs 110/798 (14 %) respectivement) (P < 0,01). La nature de l'effet clinique a été : une modification de traitement médical chez 67/125 (53 %), un changement d'intervention chirurgicale chez 38/125 (30 %), la confirmation d'un diagnostic chez 34/125 (27 %). Les conséquences sur le traitement ont été plus grandes pour des interventions chirurgicale...

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Section: Discussionmentioning

confidence: 91%

Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

Couture

Denault

McKenty

et al. 2000

Can J Anesth/J Can Anesth

100

View full text Add to dashboard Cite

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“…For instance, Yumoto et al reported 2.4% altered surgical repair method in 2002 based on TEE findings during cardiac surgery in children (18). This rate grows to more than 9% when > 12,000 cardiac surgery cases are studied by Eltzschig et al in 1990Eltzschig et al in -2005 to advise TEE in patients undergoing combined CABG and valve procedures which were, in turn, influenced by 12.3% in the case of making alternative decisions (19) as some other studies claim (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

The Frequency of Dysphagia after Intraoperative Transesophageal Echocardiography in Open Cardiac Surgery

Babaei¹,

Fard²,

Ghadrdoost³

et al. 2016

Multidiscip Cardio Annal

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Objectives: The current study tries to assess the causative factors of dysphagia and omit them to find the exact contribution of TEE for this symptom among patients who suffer from elective open cardiac surgery in different age ranges in both sexes. Methods: In this observational study, 100 patients between 30-80 years of age with ASA < III and EF > 40% who were candidate for elective open cardiac surgery in a referral hospital in Tehran in 2011 were recruited. The patients were divided into two groups based on TEE performance; patients who needed to perform TEE based on medical indication were considered the case group and the other patients who did not have indication for TEE, formed the control group. Results: Total frequency of dysphagia was 13% in all patients disregarding TEE performance while 6 (12%) and 7 (14%) of controls and cases showed this symptom respectively. Odynophagia was the other symptom to be assessed for its frequency in this study and showed 13% total frequency considering all participants disregarding the groups. This symptom was reported exactly similar to dysphagia which was 6 (12%) in controls and 7 (14%) in cases. The participants' gender was not effective on the distribution of dysphagia where 6 (11.3%) females and 7 (14.9%) males were involved with no significant difference. Conclusions: Intraoperative trans-esophageal echocardiography during cardiac surgeries has greater usefulness than complications and is worth using in this case as well.

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“…The ability of multiplane transoesophageal echocardiography (TOE) to influence anaesthetic and surgical decision making in cardiac surgery [52] has made routine TOE not only a clinically beneficial modality but also a cost-effective one [53][54][55][56][57][58][59]. The widespread use of TOE in non-cardiac surgery remains controversial.…”

Section: Intra-operative Haemodynamic Monitoringmentioning

confidence: 99%

A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility

Barber

Fletcher

2014

Anaesthesia

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Real-time intraoperative transesophageal echocardiography-how useful? experience of 5,016 cases

Cited by 129 publications

References 36 publications

Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

The Frequency of Dysphagia after Intraoperative Transesophageal Echocardiography in Open Cardiac Surgery

A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility

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