Impact of perioperative transesophageal echocardiography in aortic valve replacement.
Intraoperative transesophageal echocardiography (TEE) is currently being used routinely during aortic valve replacement (AVR). TEE provides information that can lead to modifications of anesthetic and surgical care that leads to improved outcome. Numerous studies have shown that modifications in therapy occur from 10% to more than 40% of cases. The impact of TEE can be divided among modifications of therapy before, during, and after cardiopulmonary bypass. Before cardiopulmonary bypass, TEE can provide prognostic information, optimize hemodynamics, and diagnose conditions that were not appreciated before surgery, including patient-prosthesis mismatch. TEE can guide and modify the placement of various bypass cannulae. After bypass, TEE verifies the surgical result, rules out left and right ventricular outflow tract obstruction, and assures stable hemodynamics. Although current guidelines state that aortic valve surgery is a class IIa indication for TEE use, the authors' experience suggests that TEE should be routinely used in AVR.
Qizilbash
Baqir
B
Department of Anesthesiology, Montreal Heart Institute/ Université de Montréal, Montreal, Quebec, Canada. rodriqiz@videotron.ca
Couture
Pierre
P
Denault
André
A
D001021:Aortic Valve / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods