Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach

Nicoara, Alina; Skubas, Nikolaos J.; Ad, Niv; Finley, Alan; Hahn, Rebecca T.; Mahmood, Feroze; Mankad, Sunil; Nyman, Charles; Pagani, Francis D.; Porter, Thomas R.; Rehfeldt, Kent H.; Stone, Marc E.; Taylor, Bradley S.; Vegas, Annette; Zimmerman, Karen G.; Zoghbi, William A.; Swaminathan, Madhav

doi:10.1016/j.echo.2020.03.002

Cited by 153 publications

(72 citation statements)

References 135 publications

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“…Therefore, alignment of the M-mode cursor with the longitudinal motion of the lateral tricuspid annulus should be achieved. This is simply performed in a four-chamber view by TTE [10] and needs an alternative approach by using TEE [1], since adequate alignment in TEE mid-esophageal fourchamber view is not feasible. Possible solutions addressing this issue are the use of alternative views with superior alignment or the use of alternative technologies [1].…”

Section: Conventional Echocardiographic Parametersmentioning

confidence: 99%

“…This is simply performed in a four-chamber view by TTE [10] and needs an alternative approach by using TEE [1], since adequate alignment in TEE mid-esophageal fourchamber view is not feasible. Possible solutions addressing this issue are the use of alternative views with superior alignment or the use of alternative technologies [1]. Alternative views with superior alignment exist for visualization of the RV [22].…”

Section: Conventional Echocardiographic Parametersmentioning

confidence: 99%

“…It seems to be less dependent on loading conditions [10,11]. But it has not been studied perioperatively by TEE as intensely as TAPSE, possibly because of the angle dependence of this tissue Doppler-derived parameter [1,34]. Alternative views with more accurate alignment and the use of novel technologies were reported for addressing this issue [34].…”

Section: Conventional Echocardiographic Parametersmentioning

confidence: 99%

“…Both, TTE and TEE, are crucial parts of perioperative RV function assessment [1,10]. TEE offers superior image quality and is the imaging mode of choice in the intraoperative setting complementing invasive hemodynamic measures.…”

Section: Tte Versus Tee Assessmentmentioning

confidence: 99%

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Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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Purpose of Review This review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of. Recent Findings RV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not interchangeable; while some parameters seem to correlate well, others do not. Myocardial strain analysis and three-dimensional echocardiography may overcome the limitations of conventional echocardiographic measures and provide further insight into perioperative cardiac mechanics. Summary Echocardiography has become an essential part of modern anesthesiology in patients with RV dysfunction. It offers the opportunity to evaluate not only global but also regional RV function and distinguish alterations of RV contraction.

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Section: Conventional Echocardiographic Parametersmentioning

confidence: 99%

Section: Conventional Echocardiographic Parametersmentioning

confidence: 99%

Section: Conventional Echocardiographic Parametersmentioning

confidence: 99%

Section: Tte Versus Tee Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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“…We read with great interest the recently published ''Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room.'' 1 The authors discuss the assessment of postoperative systolic anterior motion (SAM) risk for patients undergoing mitral valve repair. Risk factors for postoperative SAM include posterior leaflet elongation, decreased anterior leaflet/posterior leaflet ratio (AL:PL ratio), reduced distance between the basilar interventricular septum and mitral leaflet coaptation point (C-sept distance), [2][3][4][5][6] and decreased aortomitral angle.…”

mentioning

confidence: 99%

Correctly Estimating Systolic Anterior Motion Risk: Seeking Guidance from the Guidelines

Johnson¹,

Phelan²,

Kott³

et al. 2021

Journal of the American Society of Echocardiography

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Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

et al. 2022

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IMPORTANCEIntraoperative transesophageal echocardiography (TEE) is used frequently in cardiac valve and proximal aortic surgical procedures, but there is a lack of evidence associating TEE use with improved clinical outcomes. OBJECTIVE To test the association between intraoperative TEE use and clinical outcomes following cardiac valve or proximal aortic surgery. DESIGN, SETTING, AND PARTICIPANTS This matched, retrospective cohort study used national registry data from the Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database (ACSD) to compare clinical outcomes among patients undergoing cardiac valve or proximal aortic surgery with vs without intraoperative TEE. Statistical analyses used optimal matching within propensity score calipers to conduct multiple matched comparisons including within-hospital and within-surgeon matches, a negative control outcome analysis, and sensitivity analyses. STS ACSD data encompasses more than 90% of all hospitals that perform cardiac surgery in the US. The study cohort consisted of all patients aged at least 18 years undergoing open cardiac valve repair or replacement surgery and/or proximal aortic surgery between 2011 and 2019. Statistical analysis was performed from October 2020 to April 2021. EXPOSURES The exposure was receipt of intraoperative TEE during the cardiac valve or proximal aortic surgery. MAIN OUTCOMES AND MEASURESThe primary outcome was death within 30 days of surgery.The secondary outcomes were (1) a composite outcome of stroke or 30-day mortality and (2) a composite outcome of reoperation or 30-day mortality. RESULTSOf the 872 936 patients undergoing valve or aortic surgery, 540 229 (61.89%) were male; 63 565 (7.28%) were Black and 742 384 (85.04%) were White; 711 326 (81.5%) received TEE and 161 610 (18.5%) did not receive TEE; the mean (SD) age was 65.61 years (13.17) years. After matching, intraoperative TEE was significantly associated with a lower 30-day mortality rate compared with no TEE: 3.81% vs 5.27% (odds ratio [OR], 0.69 [95% CI, 0.67-0.72]; P < .001), a lower incidence of stroke or 30-day mortality: 5.56% vs 7.01% (OR, 0.77 [95% CI, 0.74-0.79]; P < .001), and a lower incidence of reoperation or 30-day mortality: 7.18% vs 8.87% (OR, 0.78 [95% CI, 0.76-0.80]; P < .001). Results were similar across all matched comparisons (including within-hospital, withinsurgeon matched analyses) and were robust to a negative control and sensitivity analyses.CONCLUSIONS AND RELEVANCE Among adults undergoing cardiac valve or proximal aortic surgery, intraoperative TEE use was associated with improved clinical outcomes in this cohort study.These findings support routine use of TEE in these procedures.

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Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach

Cited by 153 publications

References 135 publications

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Correctly Estimating Systolic Anterior Motion Risk: Seeking Guidance from the Guidelines

Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

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