title: [The importance of intraoperative transesophageal echocardiography in the surgical decision in cardiac surgery].
abstract: OBJECTIVE
  To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery.
  
  
  METHODS
  Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anesthesiologist in charge. The data collected were: 1) type of surgery; 2) preoperative echocardiographic diagnosis (baseline ECHO); 3) echocardiographic diagnosis before entering cardiopulmonary bypass (CPB) (pre-CPB IOTEE); 4) any differences between the baseline ECHO and the pre-CPB IOTEE (new pre-CPB finding) and whether these differences modified the planned surgery, and 5) echocardiographic diagnosis after disconnection of CPB (unexpected post-CPB finding) and whether these post-CPB echocardiographic findings led to reinstating it. The software program SPSS(®) was used for data analysis.
  
  
  RESULTS
  The total number of patients studied was 1,273. Monitoring with IOTEE showed "new pre-CPB" findings in 98 patients (7.7%), and 43.8% of these led to a change in the scheduled surgery. Of these findings, the most frequent were abnormalities of the mitral valve that had not been diagnosed, and which led to a replacement or repair that had not been scheduled. The incidence of "unexpected post-CPB findings" was 6.2% (79 patients), and 46.8% of those required reinstating the CPB and modifying the surgery performed. The failed valve repairs and dysfunctional valve prostheses were the main causes that led to re-entry into CPB. In the remaining 42 patients, with "unexpected post-CPB findings", there were no changes in the surgical procedure as the echocardiographic findings were not considered to be significant enough to re-establish CPB and revise or change the surgical procedure.
  
  
  CONCLUSIONS
  Intraoperative monitoring with IOTEE by the anesthesiologist during surgery provides important information before and after the CPB that resulted in modifying surgical management.
authors.affiliation: Departamento de Anestesiología, Hospital Universitario Quirón Dexeus, Universidad Autónoma de Barcelona, Barcelona, España. Electronic address: franempe@yahoo.com.
authors.forename: F
authors.initials: F
authors.lastname: Emperador
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: G
authors.initials: G
authors.lastname: Fita
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Arguís
authors.affiliation: Departamento de Anestesiología, Clínica del Pilar, Barcelona, España.
authors.forename: I
authors.initials: I
authors.lastname: Gómez
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: D
authors.initials: D
authors.lastname: Tresandi
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Matute
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Roux
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Gomar
authors.affiliation: Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España.
authors.forename: I
authors.initials: I
authors.lastname: Rovira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D000066491:Clinical Decision-Making; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005112:Extracorporeal Circulation; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D033162:Incidental Findings; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
keywords: Cardiac surgery; Circulación extracorpórea; Cirugía cardiaca; Ecocardiografía transesofágica; Extracorporeal circulation; Transesophageal echocardiography