The importance of intraoperative transesophageal echocardiography in the surgical decision in cardiac surgery

AIM: This study is based on the hypothesis that the routine use of transesophageal echocardiography in cardiac surgery will influence the surgical decision taken by the surgeon intra-operatively in Kasr-Alainy hospitals. METHODS: Patients were examined with intraoperative transesophageal echocardiography (TEE) before and after cardiopulmonary bypass. Complete and comprehensive intraoperative TEE examinations will be performed by TEE certified cardiac anesthesiologists. Data that will be collected from the intraoperative examination and will be compared with preoperative transthoracic echocardiography, and the surgical decision that was taken preoperatively will be revised again with the cardiothoracic surgeon before the start of surgery. Also, TEE will be used again after weaning from bypass for revision and assessment of our decision. RESULTS: We examined the utility of TEE in 100 patients undergoing different types of cardiac procedures in Kasr Al-Ainy hospital. This prospective clinical investigation found that the pre- and post-CPB TEE examinations influenced surgical decision making in 10% of all evaluated patients. CONCLUSION: Intraoperative TEE has the potential to influence clinical decision making for cardiac surgical patients significantly. It is useful in surgical planning, guiding various hemodynamic interventions, and assessing the immediate results of surgery. Thus, IOTEE should be used routinely in all patients undergoing all types of cardiac surgeries.

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Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis

Journal of Perioperative Echocardiography ◽

10.5005/jp-journals-10034-1002 ◽

2013 ◽

Vol 1 (1) ◽

pp. 16-20 ◽

Cited By ~ 1

Author(s):

Ashok Kumar Badamali ◽

J Sethu Madhavan ◽

BPS Ghuman ◽

S Subash ◽

Abhi Mishra ◽

...

Keyword(s):

Decision Making ◽

Cardiac Surgery ◽

Transesophageal Echocardiography ◽

Interim Analysis ◽

Single Center ◽

Surgical Decision ◽

New Findings ◽

Intraoperative Transesophageal Echocardiography ◽

Near Future ◽

Surgical Decision Making

ABSTRACT Transesophageal echocardiography (TEE) has become an important part of armamentarium for anesthesiologists in the management of patients undergoing cardiac surgery. Many studies have demonstrated the safety and utility of TEE in cardiac surgery. With advances in hardware and software, easy availability of resources for learning and optimal understanding of image generation and interpretation, many new findings crop up in the operating room (OR) which may have been missed in preoperative transthoracic echocardiography (TTE), leading to necessary changes in planned surgical procedure. In our retrospective analysis of 726 cases in which TEE was performed over the last 1 year, changes in decision was made in 65 (8.9%) of cases. This included 42 unanticipated findings prior to cardiopulmonary bypass and 23 new findings after CPB, requiring revision in 15 cases. With the increasing use and further impending advances of TEE, the number of cases in which surgical decision will be altered may increase in near future. How to cite this article Badamali AK, Madhavan JS, Ghuman BPS, Subash S, Raj R, Mishra A, Mishra A, Arya VK, Kumar B, Jayant A, Shyam KST, Rana SS, Singh H, Mishra A, Kuthe S, Mahajan S, Prasad S, Mathew S, Arora I, Puri GD. Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis. J Perioper Echocardiogr 2013;1(1):16-20.

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