Role of intraoperative tee and its impact on surgical decisions, prospective review of 2,261 adult cases

Intraoperative transesophageal echocardiography (IOTEE) has become an important addition to cardiac surgery. The overall impact on surgical decisions remains an important question. The purpose of this study was to prospectively evaluate the impact on surgical decisions in adult surgeries. Adult cases were defined as patients 15 years or older and did not include complex congenital cases. On all adult surgical cases performed between 1993 and 1996 with IOTEE, we assessed the impact of IOTEE by determining whether new information was found either prebypass and/or postbypass and its subsequent impact on management either prior to or after bypass. There were a total of 2,261 adult cases between 1993 and 1996; 60% of these were male and 40% were female. The age range was 15 to 93 years with a mean age of 62 ± 15 years. The most common surgeries performed were aortic valve replacement (27%), mitral valve repair (26%), and mitral valve replacement (14%). Analysis of the data showed that in 15% of the cases there was new information found prebypass that directly impacted or altered surgery in 14%. The most common new prebypass information found was: 1) insignificant mitral regurgitation and the valve was not inspected, and 2) patent foramen ovale and closure in most cases. New information was found postbypass in 5% of the cases which resulted in an alteration of surgery and/or hemodynamic management in 3%. The most common postbypass findings were: 1) new LV dysfunction or new regional wall motion abnormalities; 2) valvular dysfunction. These resulted in altered inotropic support, insertion of IABP, or return to bypass for rerepair or valve replacement. Conclusion: IOTEE has a major impact on surgery with new information found prebypass in 15% of the cases with alteration in the surgery in 14% of the cases. New information was found post bypass in 5%, and alteration in surgery in 3% of those cases.