ECHO 2013 / Perioperative Echocardiography Decision Making in the Surgical Patient
.pdf
Perioperative
Echocardiography:
Decision Making in the
Surgical Patient
Jack Shanewise, MD
Division of Cardiothoracic Anesthesiology
Columbia University College of Physicians & Surgeons
New York City, New York
No financial conflicts of interest
to disclose related to this topic
TEE during Cardiac Surgery
•UCSF reported using TEE during surgery in 1984
•Diagnostic tool to confirm and refine diagnosis in cardiac surgery
•Diagnostic tool to evaluate cardiac surgery while still in the OR
•Monitor of cardiac function during surgery
TEE during Cardiac Surgery
•1998 – PTEeXAM by SCA
•2002 – PTE training guidelines by SCA/ASE
•2004 – PTE certification by NBE
•2007 - ACGME accreditation of ACTA Fellowships incorporating advanced training in PTE
How often does intraoperative TEE alter management during cardiac surgery?
Surgical Management Altered By
Intraop Echo at Emory
1695 (90%) |
Total = 1877 |
|
|
|
Unaltered |
Altered 182 (10%)
Annals of Thoracic Surgery 85: 845-53, 2008
•Retrospective review of 12,566 intraop TEEs during cardiac surgery at B&W
•Surgical decision making influenced by TEE findings in 9.2% of cases
•82 consecutive, high risk CABG cases
•4 stage echo protocol
•Anesthesia & surgery teams blinded to findings at each stage, then asked for plan
•Changes based on echo findings documented
Ann Thorac Surg 1997;64:368-74)
•At least one major alteration in surgical management based on echo findings in 33%
•At least one major alteration in anesthetic/hemodynamic management based on echo findings in 51%
Ann Thorac Surg 1997;64:368-74)
Conclusion: Intraoperative TEE findings alter management in at least 10% of patients having cardiac surgery.