THE IMPACT OF INTRAOPERATIVE TRANSOESOPHAGEAL ECHOCARDIOGRAPHY ON DECISION-MAKING DURING CARDIAC SURGERY

Backgrounds: Real time intraoperative transoesophageal echocardiograpgy (TOE) has an expanding role in peri-operative management and surgical decision making. Objectives: Studies of the effect of transoesophageal echocardiography (TOE) on intraoperative decision making commonly emphasise major changes in operative plans. We examined more subtle effects using a novel scale, recording influences on management as follows: Level 1: TOE had no effect on management, confirmed and quantified known pathology. Level 2: TOE altered hemodynamic and /or anesthetic management. Level 3: TOE evaluated the adequacy of surgical intervention /or repair. Level 4: TOE led to an alteration in the surgical plan. We compared the impact of TOE as an aid to intra-operative management in coronary artery bypass cases with other types of cardiac surgery. Methods: Retrospective, observational study in a single centre, university-affiliated hospital included 319 patients undergoing cardiac surgery and suitable for TOE. TOE was performed in each patient before and after the institution of cardiopulmonary by-pass. Normal and abnormal echocardiographic findings as well as immediate outcomes of the surgical procedure were recorded using a standard database form. Instances where TOE lead to alteration in operative management were documented. The findings were also compared with those documented on preoperative echocardiography. Results: In 141 CABG patients TOE had a level 1 impact in 73%, level 2 impact in 11.6%, levels 3 and 4 in 7% and 7.8% respectively. In 178 non CABG patients these values were 2%, 1.6%, (p 0.05), 72.4% (p 0.05) and 23.6% (p 0.05) respectively. Conclusion: The impact of TOE in CABG procedures, while significantly less than that in non-CABG surgical procedures, remains substantial.