title: Hemodynamic transesophageal echocardiography after left ventricular assist device implantation.
abstract: OBJECTIVE
  The authors hypothesized that the clinical profile of patients undergoing hTEE after continuous flow left ventricular assist device (CF-LVAD) implant would be in patients with greater acuity, more blood product utilization, and longer length of ICU stay, and that hTEE would change clinical management.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  One hundred consecutive patients receiving a CF-LVAD.
  
  
  METHODS
  Retrospective review using a standardized electronic form of a miniaturized disposable transesophageal echocardiography probe that documented not only physical findings but also changes in hemodynamic management (hTEE) in CF-LVAD patients.
  
  
  RESULTS
  Of the 100 patients, 41 received an hTEE probe. The INTERMACS score, Leitz-Miller Score, and Kormos score indicated the hTEE group had a statistically significant greater risk of morbidity and mortality. Interoperatively, the hTEE group received more blood products and was more likely to have an open chest. Postoperatively, the hTEE group received more blood products, had a longer total length of stay, and had increased mortality. ICU length of stay, days on inotropes and days on mechanical ventilation were not statistically significant between the 2 groups. Information obtained from hTEE changed ICU management in 72% of studies.
  
  
  CONCLUSIONS
  Retrospective review of CF-LVAD patients revealed that postoperative hTEE is used in sicker CF-LVAD patients and frequently leads to changes in ICU clinical management.
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.affiliation: Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.affiliation: Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Julian S
authors.initials: JS
authors.lastname: Bick
authors.affiliation: Anesthesiology and Critical Care, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: William
authors.initials: W
authors.lastname: Costello
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Mary
authors.initials: M
authors.lastname: Keebler
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.affiliation: Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tricarico
authors.affiliation: Cardiothoracic Anesthesiology and Critical Care, Vanderbilt University Medical Center, Nashville, TN. Electronic address: chad.e.wagner@vanderbilt.edu.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color / Q000401:mortality / Q000706:statistics & numerical data*; D017548:Echocardiography, Transesophageal / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies
keywords: cardiac surgery; episodic echocardiography; hemodynamic echocardiography; intensive care management; left ventricular assist device