The Role of Transoesophageal Echocardiography in High Risk Patients Undergoing Cardiovascular Surgery

Introduction The aim of this study is to examine the role of transoesophageal echocardiography (TOE) in the evaluation and management of high risk patients undergoing cardiac-vascular surgery. Methods From March 2009 to September 2012, 2344 patients underwent cardiac surgery at the Prince Sultan Cardiac Center. Out of them, 835 were high-risk patients (Euroscore >=6). TOE was performed on 465 pts (group A) while in 370 pts (group B) only preoperative TTE was performed. There were no differences in surgical procedure between the 2 groups. In group A, left and right ventricular functions were assessed by bidimensional (left ventricular ejection fraction) and M-MODE (tricuspid anular plan systolic excursion, TAPSE) TOE. Primary end-points analysed were low output syndrome (LOS), acute renal failure (ARF), acute respiratory failure (ARespF), ICU stay, hospital stay and intraoperative mortality. Results We observed low incidence statistically significant for all the end-points in group A vs group B (LOS: 8.0% vs 16.5%, p<.05; IRA: 2.5% vs 18.5%, p<.05; ArespF: 4% vs 14%, p<.05; ICU stay: 2.0 days vs 6.0 days, p<.05; hospital stay: 8 days vs 18 days, p<.05; intraoperative mortality: 4% vs 10%, p<.05). Conclusion Intraoperative TOE evaluation is associated with better clinical outcomes. It seems related to more appropriate management of fluid administration, inotropic use and dosage, operative time reduction. All this factors led to reduce incidence of morbidity, mortality, ICU and Hospital stay. This results strongly support the routinely use of TOE in high risk patients who undergo cardiovascular surgery, and also anticipate that good results are likely to be obtained in the management of endovascular procedures.