The effect of routine intraoperative transesophageal echocardiography on surgical management

Objective: To assess the effects of routine intraoperative transesophageal echocardiography (TEE) on surgical management of patients undergoing all types of cardiac surgery. Design: Prospective, observational. Setting: A single-institution, clinical investigation, university-affiliated hospital. Participants: Two hundred eighty-three consecutive patients undergoing cardiac surgery. Interventions: A comprehensive TEE examination was performed in every patient after the induction of anesthesia. An appropriate surgical plan was then developed. A focused TEE examination was also performed at the conclusion of surgery. Whether or not TEE findings represented new information and whether or not this new information altered surgical management was documented. Measurements and Main Results: There were 106 new TEE findings in 87 patients (31%). Half of the new findings involved the mitral valve, and a quarter involved the tricuspid valve. The new TEE information altered surgical management 77 ways in 71 patients (25%). Half of the altered surgical managements involved the mitral valve, and a third involved the tricuspid valve. In 8 patients (3%), TEE information influenced decisions regarding use/nonuse of cardiopulmonary bypass (CPB). In 2 patients, TEE examination after the separation from CPB prompted reinitiation of CPB. In 1 patient, TEE examination after the induction of general anesthesia prompted cancellation of surgery. Conclusions: The routine use of TEE during cardiac surgery revealed new cardiac pathology in 1 of every 3 patients and led to altered surgical management in 1 of every 4 patients. TEE information also influenced decisions regarding use/nonuse of CPB in 3% of patients. Thus, the authors suggest that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery. (C) 2007 Elsevier Inc. All rights reserved.