title: The value of intraoperative transesophageal echocardiography in patients undergoing aortic valve replacement.
abstract: OBJECTIVE
  While the role of intraoperative transesophageal echocardiography (IOTEE) in valve repair surgery is well documented, its value in patients undergoing valve replacement is debatable. The study aim was to assess the impact of IOTEE on the management of a large cohort of patients referred for aortic valve replacement (AVR).
  
  
  METHODS
  The departmental echocardiography database for patients undergoing AVR with IOTEE between April 1999 and September 2006 at the authors' institution was reviewed. Patients with a diagnosis of infective endocarditis, aortic dissection, or those in whom a composite graft was implanted, were excluded from the study.
  
  
  RESULTS
  The study group included 604 patients (319 males, 285 females; mean age 70 +/- 11 years) who underwent AVR for either predominant aortic stenosis (n = 520; 86.1%) or aortic regurgitation (n = 84; 13.9%). Pre-pump IOTEE was performed in 440 patients (72.8%), and post-pump IOTEE in 586 (97.0%). Overall major preoperative findings influencing the operative plan were found in 106 of the 440 patients (24.1%); decisions regarding the mitral valve were the most frequent. The post-pump study revealed unexpected findings requiring a second pump run in 20 patients (3.4%), of whom nine cases (1.5%) applied to the replaced aortic prostheses (paravalvular leak in five patients, coronary obstruction by an aortic bioprosthesis in two, and detection and closure of a pseudoaneurysm in the mitral-aortic fibrosa and incompetent bioprosthesis in one patient each). Eleven patients (1.8%) required a second pump run because of failed mitral/tricuspid repair or hemodynamic compromise.
  
  
  CONCLUSIONS
  The main use of a routine application of IOTEE among patients undergoing AVR was to detect additional lesions preoperatively, and technical failures postoperatively.
authors: The Dan Sheingarten Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel. wisnberg@zahav.net.il
authors: Daniel
authors: D
authors: Weisenberg
authors: Alik
authors: A
authors: Sagie
authors: Mordehay
authors: M
authors: Vaturi
authors: Daniel
authors: D
authors: Monakier
authors: Erez
authors: E
authors: Sharoni
authors: Eyal
authors: E
authors: Porat
authors: Yaron
authors: Y
authors: Shapira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure