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

Abstract

SummaryThe 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.

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

“…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.…”

Perioperative Echocardiography

“…Changes in surgical decisions will also be influenced by patient consent, specific choices of surgically implanted devices, and the benefit-risk of morbidity and/or mortality based on the complexity of the procedure. 11 The American College of Cardiology and the American Heart Association have presented their recommendations for the use of POE, in which they provided three categories of guidelines (Classes I, IIa, IIb, and III). 3 It is suggested that IOE is most beneficial for patients in Classes I and IIa, which include but are not limited to valvular repairs and replacements, hypertrophic obstructive cardiomyopathy (HOCM), aortic dissection, congenital heart disease repair, transcatheter aortic valve implantation, aneurysm repair, heart transplant, and ventricular assist device implantation.…”

Transesophageal Echocardiography for the Noncardiac Surgical Patient

“…The diameter of the aortic valve opening is marked (1). The aortic diameter at the sinotubular junction is marked (2). The flap (F) indicates the ascending aorta dissection in both graphs.…”

“…1 Although not all patients benefit from TEE during cardiac surgery and its use for cardiac surgery varies among institutions, guidelines have been established to assist with patient selection. 2,3 Recently, the American Society of Anesthesiologists updated their practice guidelines for perioperative TEE use. 4 Recommendations for TEE use for noncardiac surgery were established.…”