Impact of intraoperative transesophageal echocardiography on decision making during aortic and mitral valve surgery in children

Abstract Background With this study we aimed to analyze if the separate consideration of body mass index (BMI) could provide any superior predictive values compared with the established risk scores in isolated minimally invasive mitral valve surgery (MIMVS). This might facilitate future therapeutic decision-making, e.g., regarding the question surgery versus transcatheter mitral valve repair (TMVr). Methods We assessed the relevance of BMI in non-underweight patients who underwent isolated MIMVS. The risk predictive potential of BMI for mortality and several postoperative adverse events was assessed in 429 consecutive patients. This predictive potential was compared with that of European System for Cardiac Outcome Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons score (STS score) using a comparative receiver operating characteristic curve analysis. Results BMI was a significant numeric predictor of wound healing disorders (p = 0.001) and proved to be significantly superior in case of this postoperative adverse event compared with the EuroSCORE II (p = 0.040) and STS score (p = 0.015). Except for this, the predictive potential of BMI was significantly inferior compared with that of the EuroSCORE II and STS score for several end points, including 30-day (p = 0.029 and p = 0.006) and 1-year (p = 0.012 and p = 0.001) mortality. Conclusion Therefore, we suggest that, in the course of decision-making regarding the right treatment modality for non-underweight patients with isolated mitral valve regurgitation, the sole factor of BMI should not be given a predominant weight.

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Echocardiography for Intraoperative Decision Making in Mitral Valve Surgery—A Pilot Simulation-Based Training Module

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2017.05.027 ◽

2017 ◽

Vol 31 (5) ◽

pp. 1728-1732 ◽

Cited By ~ 1

Author(s):

Rex Joseph Morais ◽

Balakrishnan Ashokka ◽

Suresh Paranjothy ◽

Chiang Siau ◽

Lian Kah Ti

Keyword(s):

Decision Making ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Training Module ◽

Simulation Based

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Faculty Opinions recommendation of Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726178763.793514948 ◽

2016 ◽

Author(s):

Jonathan Mark

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Transesophageal Echocardiography ◽

Mitral Valve Surgery ◽

Valve Surgery

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Surgical Echocardiography of the MV: Focus on 3D

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253218789409 ◽

2018 ◽

Vol 23 (1) ◽

pp. 26-36 ◽

Cited By ~ 2

Author(s):

Meena Bhatia ◽

Priya Kumar ◽

Susan M. Martinelli

Keyword(s):

Mitral Valve ◽

Transesophageal Echocardiography ◽

Color Doppler ◽

Complex Structure ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Multiple Forms ◽

Surgical Interventions ◽

3 Dimensional ◽

Valvular Diseases

The mitral valve remains a complex structure where multiple forms of pathology can be seen. Mitral regurgitation continues to be one of the most common valvular diseases in the industrialized world. While intraoperative 2-dimensional transesophageal echocardiography has been commonplace for some time, 3-dimensional technology has emerged and has shown great benefit for diagnosis and guidance during mitral valve surgery. In the hands of a trained sonographer, high-quality real-time images can easily be obtained and correlate well with gross anatomical findings. The use of multiple angled views and color Doppler within 3-dimensional transesophageal echocardiography has become a valuable asset in the understanding and interpretation of the mitral valve for surgical interventions.

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