Perioperative transoesophageal echocardiography: current status and future directions

Abstract

Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions. Additionally, 3D imaging has facilitated the advent of minimally invasive and percutaneous interventions for structural heart disease. Information derived from TEE is routinely used to evaluate a patient's suitability for an intervention, provide guidance during the intervention and eventually comment on the quality and success of the procedure. Expertise in perioperative TEE is an integral component of a cardiac anaesthesiologist's skill sets. With structural heart disease interventions becoming more minimally invasive, the intraoperative guidance provided by TEE will continue to be a critical component of these procedures. With improving computational and processing power, the expectations from TEE will continue to be incremental in the perioperative arena.

The Emperor Has No Clothes: Recognizing the Limits of Current Echocardiographic Technology in Perioperative Quantification of Mitral Regurgitation

“…The field is receiving renewed attention with the advent of catheter-based structural cardiac interventions. 26 The meta-analysis by Sanfilippo et al highlight a profound problem with the current ability to assess mitral regurgitation in patients receiving anesthesia. 3 The way forward does not lie in complacency and stagnation.…”

2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography)

“…In addition, exposure to a wide range of cardiac surgical procedures is recommended. These include procedures for mechanical circulatory support, robotic or minimally invasive procedures, and hybrid techniques, where TEE guidance is important for specific portions of the procedure, such as identification of intracardiac catheters, cannulae, devices, and guidewires …”

“…These include procedures for mechanical circulatory support, robotic or minimally invasive procedures, and hybrid techniques, where TEE guidance is important for specific portions of the procedure, such as identification of intracardiac catheters, cannulae, devices, and guidewires. 36 Guidelines for training in advanced intraoperative TEE have been developed primarily for the cardiovascular anesthesiologist who has not had prior training in routine TEE. 21…”

Einfluss der Kardioanästhesie auf das Patientenoutcome

“…Die Richtlinien der deutschen und internationalen Fachgesellschaften sehen die perioperative Echokardiografie die sowohl den Zeitraum vor, während und unmittelbar nach dem operativen Eingriff sowie die Zeit der intensivmedizinischen Versorgung umfasstzum hämodynamischen Monitoring als auch zur kardialen Diagnostik während herzchirurgischer Eingriffe vor [12,16]. [15].…”