title: Intraoperative changes in regional wall motion: can postoperative coronary artery bypass graft failure be predicted?
abstract: OBJECTIVE
  To evaluate the accuracy of new intraoperative regional wall motions abnormalities (RWMAs) detected by transesophageal echocardiography (TEE) to predict early postoperative coronary artery graft failure.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  A tertiary care university hospital.
  
  
  METHODS
  Five thousand nine hundred ninety-eight patients who underwent coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  An evaluation of RWMAs recorded with intraoperative TEE before and after cardiopulmonary bypass (CPB) in patients who had coronary angiography for suspected postoperative myocardial ischemia based on electrocardiogram (ECG), CK-MB, troponin T, hemodynamic compromise, low cardiac output, and malignant ventricular arrhythmia. Sensitivity, specificity, positive and negative predictive values, odds ratio, 95% confidence interval, and chi-square analysis were used.
  
  
  RESULTS
  Thirty-nine patients (0.7%) underwent early coronary angiography for the suspicion of early graft dysfunction. Of the 32 patients with diagnosed early graft dysfunction, 5 patients (15.6%) had shown new intraoperative RWMAs as detected by TEE, 21 patients (65.6%) had no new RWMAs, no report was available in 5 patients (15.6%), and 1 examination (3.1%) was excluded because of poor imaging quality. The sensitivity of TEE to predict graft failure was 15.6%, the specificity was 57.1%, and the positive predictive and negative values were 62.5% and 12.9%, respectively. The odds ratio and 95% confidence interval was 0.1190 (0.0099-1.4257) when TEE was positive compared with coronary angiography. No association was found between new RWMAs detected with TEE and graft failure as documented with coronary angiography (p = 0.106).
  
  
  CONCLUSIONS
  In this retrospective study, RWMAs detected with TEE were of limited value to predict early postoperative CABG failure.
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: De Mey
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Maxime
authors.initials: M
authors.lastname: Laflamme
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Alain
authors.initials: A
authors.lastname: Deschamps
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Rochon
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging*