title: Is Transesophageal Echocardiography Needed before Hospital Discharge in Patients after Bentall Surgery?
abstract: Whether transesophageal echocardiography (TEE) should be routinely performed before hospital discharge after Bentall surgery remains unclear. The investigators took advantage of this practice at their institution to evaluate its benefit.
  
  
  
  All patients who had undergone the Bentall procedure at Bichat Hospital from January 2010 to March 2014 were included. For each patient, transthoracic echocardiographic and transesophageal echocardiographic data and clinical events were retrospectively collected from the various reports.
  
  
  
  One hundred ninety-eight patients underwent the Bentall procedure during the study period. Postoperative TEE was performed in 117 patients (59.1%), including nine with abnormalities observed on transthoracic echocardiography (a vibrating element on the new prosthetic valve, suspicion of peritubular complications in two patients, and aortic regurgitation in six patients). In 108 patients, routine TEE was performed (i.e., without clinical indication beyond baseline postoperative imaging). Patients with and those without routine TEE were identical, except for more frequent endocarditis as an indication for surgery in patients with routine TEE. Routine TEE did not reveal any new findings that prior transthoracic echocardiography had not shown. The most frequent finding on transthoracic echocardiography or TEE was periaortic hematoma, which sometimes led to the performance of computed tomography. This imaging did not change the care of the patients in this population.
  
  
  
  This study does not support the performance of TEE after Bentall surgery during the in-hospital course in the absence of a specific indication. Baseline postoperative imaging using TEE or computed tomography should preferably be recommended beyond the early postoperative period after periaortic hematoma has resolved.
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France.
authors.forename: Victor
authors.initials: V
authors.lastname: Waldmann
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Milleron
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.affiliation: Department of Cardiac Surgery, Bichat Hospital, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.affiliation: Department of Cardiac Surgery, Bichat Hospital, Paris, France.
authors.forename: Walid
authors.initials: W
authors.lastname: Ghodbane
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; Department of Cardiac Surgery, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France. Electronic address: guillaume.jondeau@aphp.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
mesh_terms: D017677:Age Distribution; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014600:Utilization Review
keywords: Aorta; Bentall; Cardiac imaging techniques; Cardiac surgery; Echocardiography