Intraoperative transesophageal echocardiography modifies strategy in off-pump coronary artery bypass grafting.
BACKGROUND
Off-pump coronary artery bypass graft surgery (OPCAB) can improve operative morbidity and mortality in high risk patients. Intraoperative transesophageal echocardiography (ITEE) is being employed increasingly during cardiac surgery.


METHODS
Routine ITEE was performed in 744 OPCAB patients performed over a five year period. Mean patient age was 69.1 +/- 8.0 years. There were a high percentage of patients over 70 years (39%), diabetics (26%), poor left ventricular function (< or = 35%) (31%), recent myocardial infarction (24%), unstable angina (15%), and preoperative intraaortic balloon pump (5.6%); mean graft number was 3.4.


RESULTS
There was a major modification in intraoperative strategy in 117 patients (16%) and minor modification in 77 patients (10%) due to information available through the ITEE (total 26%). Graft revision was performed in 39 patients, graft construction was modified due to severe ascending aortic atherosclerosis in 31, and an intraoperative intraaortic balloon pump was placed due to previously underappreciated left ventricular dysfunction and new intraoperative left ventricular dysfunction in 37 patients. Ten patients were placed on cardiopulmonary bypass due to previously unknown intracardiac pathology (three atrial septal defect repairs and five valvular procedures, two others). Intracoronary shunts were placed due to new wall motion changes during anastomosis in 77 patients. There were two emergent conversions to cardiopulmonary bypass. There were no complications due to ITEE probe placement.


CONCLUSIONS
Intraoperative transesophageal echocardiography is a valuable adjunct and can result in a major change of surgical strategy in a significant number of patients when used routinely for OPCAB. It may also improve surgical outcome and add to the OPCAB benefits.
Gurbuz
Ahmet Tayfun
AT
Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Tucson Heart Hospital, Tucson, Arizona, USA. atgurbuz@yahoo.com
Hecht
Michael L
ML
Arslan
Ahmet Hulisi
AH
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000000981:diagnostic imaging; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004638:Emergency Treatment; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D007423:Intra-Aortic Balloon Pumping; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy