title: Transesophageal echocardiography or fluoroscopy during port-access surgery?
abstract: BACKGROUND
  In Port-Access cardio-surgical procedures, both intraoperative transesophageal echocardiography (TEE) and fluoroscopy can be used for placement of the catheters and cannulae needed for cardiopulmonary bypass. Our study sought to clarify whether it is possible to rely exclusively on TEE for catheter placement without increasing the risk for the patient.
  
  
  METHODS
  Forty patients underwent cardiac surgery with the Port-Access system. Fluoroscopy as well as TEE were used for placement of the transjugular and transfemoral catheters required for cardiopulmonary bypass. The time required for fluoroscopy was recorded, as were any complications during cannulation and cardiopulmonary bypass.
  
  
  RESULTS
  The average fluoroscopy time was 10.7 +/- 12.1 min. Fluoroscopy time required for placement of the coronary sinus and pulmonary vent catheters could be reduced to zero early in the course of the study. Once we had gained enough experience with TEE, fluoroscopy for placement of the transfemoral catheters was also no longer necessary. During cannulation, 3 patients suffered complications requiring immediate surgical intervention. These complications were all diagnosed by TEE.
  
  
  CONCLUSIONS
  Our data suggest that positioning of the coronary sinus and the pulmonary vent catheters is safe and practicable with TEE alone. Nonetheless, if TEE imaging is poor or fails, fluoroscopy has still a place in Port-Access surgery and should always be available intraoperatively.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Control, J W Goethe-University Hospital, Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Mierdl
authors.forename: D
authors.initials: D
authors.lastname: Meininger
authors.forename: C
authors.initials: C
authors.lastname: Byhahn
authors.forename: T
authors.initials: T
authors.lastname: Aybek
authors.forename: P
authors.initials: P
authors.lastname: Kessler
authors.forename: K
authors.initials: K
authors.lastname: Westphal
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors