Multinational institutional survey on patterns of intraoperative transesophageal echocardiography use in adult cardiac surgery.
OBJECTIVE
To assess institutional patterns of perioperative transesophageal echocardiography (TEE) usage.


METHODS
The authors hypothesized that TEE is performed more frequently and comprehensively in academic centers, mainly by anesthesiologists, and barriers to performing TEE are due to inadequate resources. A survey was deployed to selected participants. Collated responses were assessed for demographic patterns in TEE practice, and 2-category comparisons were made with Chi-squared association tests.


METHODS
Web-based survey.


METHODS
Practitioners in cardiovascular anesthesia/surgery in 200 institutions.


METHODS
None.


RESULTS
Surveys were completed by respondents representing 200 centers in 27 countries and 1,727 anesthesiologists with a mean annual institutional volume of 924 cases. Most centers were in the USA (53%) and were defined as academic (83%). Anesthesiologists performed (85%) and also read/reported TEEs (78%) in most centers. Three-dimensional TEE is performed routinely at 40% of centers. TEE is used routinely for valve surgery in 95% of institutions compared to 68% for coronary artery bypass graft surgery. Academic institutions assessed diastolic function more often than nonacademic centers (46% v 19%; p = 0.006). The most important reason cited for not using TEE in all cases was insufficient resource availability (47%).


CONCLUSIONS
These results suggest that TEE is performed more comprehensively in academic centers, mainly by anesthesiologists, and that lack of resources is a significant barrier to routine TEE usage. TEE is used more often for valve surgery than for coronary artery bypass graft surgery, and many centers use 3D TEE. This survey describes international TEE practice patterns and identifies limitations to universal adoption of TEE in cardiac surgery.
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Heather A
HA
Dobbs
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Elliott
E
Bennett-Guerrero
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
William
W
White
Department of Anesthesiology and Perioperative Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Stanton K
SK
Shernan
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Alina
A
Nicoara
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
J Mauricio
JM
Del Rio
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Mark
M
Stafford-Smith
Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: madhav.swaminathan@duke.edu.
Madhav
M
Swaminathan
D000328:Adult; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*
clinical practice patterns, international; echocardiography; survey; transesophageal