title: The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice.
abstract: The use of transoesophageal echocardiography during cardiac surgery has increased dramatically and it is now widely accepted as a routine monitoring and diagnostic tool. A prospective study was carried out between September 2004 and September 2007, and included all patients in whom intra-operative echocardiography was performed, 2 473 (44%) out of a total of 5 591 cases. Changes to surgery were subdivided into predictable (where echocardiographic examination was planned specifically to guide surgery) and unpredictable (new pathology not diagnosed pre-operatively). A change in the planned surgical procedure was documented in 312 (15%) cases. In 216 (69%) patients the changes were predictable and in 96 (31%) they were unpredictable. The number of predictable changes increased between 2004-5 and 2006-7 (8% vs 13%, p = 0.025). In these cases, intra-operative echocardiography was specifically requested by the surgeon to help determine the operative intervention. This has implications for consent and operative risk, which have yet to be fully determined.
authors.affiliation: Department of Anaesthesia and Critical Care, Papworth Hospital, Cambridge, UK. Andrew.Klein@papworth.nhs.uk
authors.forename: A A
authors.initials: AA
authors.lastname: Klein
authors.forename: A
authors.initials: A
authors.lastname: Snell
authors.forename: S A M
authors.initials: SA
authors.lastname: Nashef
authors.forename: R M O
authors.initials: RM
authors.lastname: Hall
authors.forename: J D
authors.initials: JD
authors.lastname: Kneeshaw
authors.forename: J E
authors.initials: JE
authors.lastname: Arrowsmith
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D003657:Decision Making; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies