Impact of intraoperative transesophageal echocardiography in patients undergoing valve replacement.
BACKGROUND
The role of intraoperative transesophageal echocardiography (IOTEE) in valve replacement surgery is not well established. The aim of this study was to explore the impact of immediate postpump IOTEE in valve replacement surgery at a single tertiary medical center.


METHODS
The departmental database was screened for valve replacement operations (mechanical or bioprosthetic valves) performed during a 55-month period that were succeeded by immediate postpump IOTEE. Data was gathered regarding the impact of IOTEE on the immediate postoperative course.


RESULTS
The study group included 417 patients (44.8% male, 55.2% female, age 65.2 +/- 13.9 years). Prepump IOTEE was performed in 352 patients (84.4%). A single valve was replaced in 336 patients (80.6%) and two or more valves were replaced in 81 patients (19.4%). Overall 501 valves were inserted: mitral, 237 (131 mechanical, 106 biological); aortic, 221 (89 mechanical, 132 biological); tricuspid, 43 (2 mechanical, 41 biological). Unexpected pathologic echocardiographic findings on postpump IOTEE necessitated immediate surgical correction in 15 patients (3.6%): perivalvular leak in 8 patients (4 mitral, 4 aortic), immobilized leaflet in 4 patients (3 mitral, 1 tricuspid), coronary obstruction by an aortic bioprosthesis in 2 patients, and incompetent xenograft in 1 patient. Prolonged removal of air was necessary in 45 patients (10.8%). In 47 patients (11.3%) the postpump IOTEE contributed to the evaluation of difficult weaning from the bypass pump and to its appropriate therapeutic management (volume expansion, inotropic agents, vasodilators, or mechanical assistance).


CONCLUSIONS
Immediate postpump IOTEE is an important diagnostic and therapeutic role in valve replacement surgery and should be widely implemented.
The Dan Sheingarten Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel. yshapira@post.tau.ac.il
Yaron
Y
Shapira
Mordehay
M
Vaturi
Daniel E
DE
Weisenberg
Ehud
E
Raanani
Gideon
G
Sahar
Eitan
E
Snir
Alexander
A
Battler
Bernardo A
BA
Vidne
Alex
A
Sagie
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery; D002315:Cardiopulmonary Bypass; D017115:Catheter Ablation; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000209:etiology / Q000601:surgery / Q000628:therapy; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology