6/21/2023 0 Comments Definition of aortic arch5 - 9 However, the current American Heart Association (AHA) and American College of Cardiology (ACC) guidelines do not specifically recommend for or against the use of intraoperative TEE in the majority of cardiac surgical procedures 10 - 12 because prior to 2020, observational studies have not directly associated intraoperative TEE with improved clinical outcomes. 4 Transesophageal echocardiography (TEE) is an ultrasonography-based, cardiac imaging tool used in cardiac surgical procedures to facilitate informed surgical decision making 5 - 7 and manage intraoperative complications. These findings support routine use of TEE in these procedures.Įach year, 150 000 patients undergo high-risk, 1 - 3 open cardiac valve or proximal aortic surgery in the US. Results were similar across all matched comparisons (including within-hospital, within-surgeon matched analyses) and were robust to a negative control and sensitivity analyses.Ĭonclusions and Relevance Among adults undergoing cardiac valve or proximal aortic surgery, intraoperative TEE use was associated with improved clinical outcomes in this cohort study. After matching, intraoperative TEE was significantly associated with a lower 30-day mortality rate compared with no TEE: 3.81% vs 5.27% (odds ratio, 0.69 P < .001), a lower incidence of stroke or 30-day mortality: 5.56% vs 7.01% (OR, 0.77 P < .001), and a lower incidence of reoperation or 30-day mortality: 7.18% vs 8.87% (OR, 0.78 P < .001). The secondary outcomes were (1) a composite outcome of stroke or 30-day mortality and (2) a composite outcome of reoperation or 30-day mortality. Main Outcomes and Measures The primary outcome was death within 30 days of surgery. Statistical analysis was performed from October 2020 to April 2021.Įxposures The exposure was receipt of intraoperative TEE during the cardiac valve or proximal aortic surgery. The study cohort consisted of all patients aged at least 18 years undergoing open cardiac valve repair or replacement surgery and/or proximal aortic surgery between 20. STS ACSD data encompasses more than 90% of all hospitals that perform cardiac surgery in the US. Statistical analyses used optimal matching within propensity score calipers to conduct multiple matched comparisons including within-hospital and within-surgeon matches, a negative control outcome analysis, and sensitivity analyses. Objective To test the association between intraoperative TEE use and clinical outcomes following cardiac valve or proximal aortic surgery.ĭesign, Setting, and Participants This matched, retrospective cohort study used national registry data from the Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database (ACSD) to compare clinical outcomes among patients undergoing cardiac valve or proximal aortic surgery with vs without intraoperative TEE. Importance Intraoperative transesophageal echocardiography (TEE) is used frequently in cardiac valve and proximal aortic surgical procedures, but there is a lack of evidence associating TEE use with improved clinical outcomes. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.
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