Intraoperative transesophageal echocardiography in minimally invasive cardiac valve surgery.
The minimally invasive procedure is a new surgical technique that uses a small sternal incision. Because of limited surgical exposure, removal of intracavitary air and visual assessment of cardiac function are not possible. We studied the utility of intraoperative transesophageal echocardiography (IOE) before and after cardiopulmonary bypass in 112 patients (mean age 53.1 +/- 15.2 years, 74 males) who underwent minimally invasive valvular surgery. Surgical procedures included 52 isolated mitral valve procedures (49 repairs, 3 prostheses), 58 isolated aortic valve procedures (16 repairs, 26 prostheses, 16 homografts), and 2 combined aortic and mitral valve repairs. Prepump IOE was useful to confirm valve dysfunction and assist determination of arterial cannulation site. Postpump IOE identified intracardiac air in all patients, which was defined as extensive in 58 (52%) cases. Postoperatively, new left ventricular dysfunction was noted in 22 (20%) patients, more often in the group with extensive air by IOE (17 [30%] of 58 patients) compared with those without extensive air (5 [10%] of 54 patients, P =.01). Second pump runs were required in 7 (6%) of 112 patients: 3 cases of residual aortic regurgitation, 1 case of residual mitral regurgitation, and 3 cases with new ventricular dysfunction. No deaths occurred. We conclude that IOE is essential in minimally invasive valvular surgery because it detects problems that require immediate remedy. IOE allows real-time assessment of ventricular filling, ventricular and valvular function, and intracardiac air.
Secknus
M A
MA
Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195-5064, USA.
Asher
C R
CR
Scalia
G M
GM
Cosgrove
D M
DM
Stewart
W J
WJ
D000388:Air; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery* / Q000637:transplantation; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D002302:Cardiac Output / Q000502:physiology; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000209:etiology; D002315:Cardiopulmonary Bypass; D002406:Catheterization, Peripheral / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D014184:Transplantation, Homologous; D018084:Ultrasonography, Interventional; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology; D016276:Ventricular Function / Q000502:physiology