Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery

Abstract

Background: Despite recommendations regarding the use of intraoperative transesophageal echocardiography (TEE), there is no randomized evidence to support its use in cardiac valve surgery. The purpose of this study was to compare the clinical outcomes of patients undergoing open cardiac valve repair or replacement surgery with and without transesophageal echocardiographic monitoring. The hypothesis was that transesophageal echocardiographic monitoring would be associated with lower 30-day mortality and shorter length of hospitalization. Methods: In this observational retrospective cohort study, Medicare claims were used to test the association between perioperative TEE and 30-day all-cause mortality and length of hospitalization among patients undergoing open cardiac valve repair or replacement surgery between January 1, 2010, and October 1, 2015. Baseline characteristics were defined by inpatient and outpatient claims. Medicare death records were used to ascertain 30-day mortality. Statistical analyses included regression models and propensity score matching. Results: A total of 219,238 patients underwent open cardiac valve surgery, of whom 85% underwent TEE. Patients who underwent TEE were significantly older and had greater comorbidities. After adjusting for patient demographics, clinical comorbidities, surgical characteristics, and hospital factors, including annual surgical volume, the TEE group had a lower adjusted odds of 30-day mortality (odds ratio, 0.77; 95% CI, 0.73 to 0.82; P < .001), with no difference in length of hospitalization (<0.01%; 95% CI, À0.61% to 0.62%; P = .99). Results were similar across all analyses, including a propensity score-matched cohort. Conclusions: Transesophageal echocardiographic monitoring in cardiac valve repair or replacement surgery was associated with lower 30-day risk-adjusted mortality, without a significant increase in length of hospitalization. These findings support the use of TEE as routine practice in open cardiac valve repair or replacement surgery.

Association between Transesophageal Echocardiography and Clinical Outcomes after Coronary Artery Bypass Graft Surgery

“…The choice of CPT codes to define the exposure of TEE was based on our prior work using claims data to identify TEE from CPT claims. 21,22,32 As can be seen by the descriptors for each CPT code for TEE listed the Supplemental Appendix, Section 1, there is no CPT code that specifically identifies intraoperative TEE. However, sensitivity analyses from our group's previous work using private payer claims data (containing precise CPT procedural date information not found in Medicare claims) demonstrated consistent results whether the TEE exposure was defined as intraoperative (with a CPT billing date within 1 calendar day of the cardiac surgery CPT billing date) or perioperative (with a CPT billing date at any time within the index hospitalization).…”

“…Thus, consistent with our previous work, we chose to include any hospitalization TEE claim as evidence of perioperative TEE receipt. 21,22,32…”

A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case report

“…Only recently, however, were favourable outcomes from its use seen in a study of 219,238 valve surgery patients. 22 Therefore, it is unlikely that TCD will be studied in sufficient numbers to clearly be associated with improvement in overall outcomes. We use TCD in the operating room and in the intensive care unit as a warning device to detect unilateral or bilateral brain malperfusion, venous hypertension, intracranial hypertension, air embolism or HITS, and as a complement to oximetry and Fig.…”

Echocardiography in Infective Endocarditis: An Update on its Usefulness: How, When, How Much and Where?

“…TTE show a sensitivity of 50-70% for the diagnosis of vegetations, but it should be taken into account that a suboptimal ultrasound window and small vegetations would significantly decrease this diagnostic sensitivity. TEE is especially useful in these cases for the detection of vegetations, increasing sensitivity up to 90% (MacKay et al, 2020). TEE has also demonstrated to be clearly superior in the IE diagnosis over valvular prostheses, intracavitary devices and pacemakers.…”

“…It will help to better plan the subsequent surgery. Post-pump TEE will give us information on the result of the surgery, especially when conservative or very complex surgery is performed (MacKay et al, 2020). In up to 10% of the operations it can lead to perform a second pump entry and to change the pre-surgery plans in 11% (Shapira et al, 2007).…”