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Impact of intraoperative transesophageal echocardiography in patients undergoing valve replacement.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2004 Aug; Vol. 78 (2), pp. 579-83; discussion 583-4. - Publication Year :
- 2004
-
Abstract
- Background: The role of intraoperative transesophageal echocardiography (IOTEE) in valve replacement surgery is not well established. The aim of this study was to explore the impact of immediate postpump IOTEE in valve replacement surgery at a single tertiary medical center.<br />Methods: The departmental database was screened for valve replacement operations (mechanical or bioprosthetic valves) performed during a 55-month period that were succeeded by immediate postpump IOTEE. Data was gathered regarding the impact of IOTEE on the immediate postoperative course.<br />Results: The study group included 417 patients (44.8% male, 55.2% female, age 65.2 +/- 13.9 years). Prepump IOTEE was performed in 352 patients (84.4%). A single valve was replaced in 336 patients (80.6%) and two or more valves were replaced in 81 patients (19.4%). Overall 501 valves were inserted: mitral, 237 (131 mechanical, 106 biological); aortic, 221 (89 mechanical, 132 biological); tricuspid, 43 (2 mechanical, 41 biological). Unexpected pathologic echocardiographic findings on postpump IOTEE necessitated immediate surgical correction in 15 patients (3.6%): perivalvular leak in 8 patients (4 mitral, 4 aortic), immobilized leaflet in 4 patients (3 mitral, 1 tricuspid), coronary obstruction by an aortic bioprosthesis in 2 patients, and incompetent xenograft in 1 patient. Prolonged removal of air was necessary in 45 patients (10.8%). In 47 patients (11.3%) the postpump IOTEE contributed to the evaluation of difficult weaning from the bypass pump and to its appropriate therapeutic management (volume expansion, inotropic agents, vasodilators, or mechanical assistance).<br />Conclusions: Immediate postpump IOTEE is an important diagnostic and therapeutic role in valve replacement surgery and should be widely implemented.
- Subjects :
- Adult
Aged
Aged, 80 and over
Air
Atrial Fibrillation complications
Atrial Fibrillation surgery
Cardiopulmonary Bypass
Catheter Ablation
Coronary Artery Bypass
Coronary Disease complications
Coronary Disease etiology
Coronary Disease surgery
Coronary Disease therapy
Female
Heart Valve Diseases complications
Heart Valve Diseases surgery
Humans
Intra-Aortic Balloon Pumping
Intraoperative Complications etiology
Intraoperative Complications surgery
Male
Middle Aged
Retrospective Studies
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Dysfunction, Left etiology
Echocardiography, Transesophageal
Heart Valve Prosthesis Implantation
Intraoperative Care methods
Intraoperative Complications diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 78
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 15276525
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2004.02.075