title: Intraoperative echocardiography is indicated in high-risk coronary artery bypass grafting.
abstract: BACKGROUND
  Intraoperative echocardiography is a valuable monitoring and diagnostic technology used in cardiac surgery. This reports our clinical study of the usefulness of intraoperative echocardiography to both surgeons and anesthesiologists for high-risk coronary artery bypass grafting.
  
  
  METHODS
  From March to November 1995, 82 consecutive high-risk patients undergoing coronary artery bypass grafting were studied in a four-stage protocol to determine the efficacy of intraoperative echocardiography in management planning. Alterations in surgical and anesthetic/hemodynamic management initiated by intraoperative echocardiography findings were documented in addition to perioperative morbidity and mortality.
  
  
  RESULTS
  Intraoperative echocardiography initiated at least one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortality and the rate of myocardial infarction in this consecutive high-risk study population using intraoperative echocardiography and in a similar group of patients without the use of intraoperative echocardiography was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not significant), respectively.
  
  
  CONCLUSIONS
  We conclude that when all of the isolated diagnostic and monitoring applications of perioperative echocardiography are routinely and systematically performed together, it is a safe and viable tool that significantly affects the decision-making process in the intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients.
authors.affiliation: Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Savage
authors.forename: B W
authors.initials: BW
authors.lastname: Lytle
authors.forename: S
authors.initials: S
authors.lastname: Aronson
authors.forename: J L
authors.initials: JL
authors.lastname: Navia
authors.forename: M
authors.initials: M
authors.lastname: Licina
authors.forename: W J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: N J
authors.initials: NJ
authors.lastname: Starr
authors.forename: F D
authors.initials: FD
authors.lastname: Loop
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D004452:Echocardiography; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D007432:Intraoperative Period; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D012307:Risk Factors