Intraoperative transesophageal echocardiography may lower mortality risk after CABG
Click Here to Manage Email Alerts
Intraoperative transesophageal echocardiography during CABG was associated with lower odds of 30-day mortality, particularly among higher-risk patients, a speaker reported.
According to research presented at the American College of Cardiology Scientific Session, intraoperative transesophageal echocardiography (TEE) also improved the likelihood of detecting a necessary valve procedure at the time of CABG.
“Intraoperative TEE to support CABG is a guideline-recommended means to assess intraoperative cardiac structure and function, given a IIa recommendation in the last CABG guidelines,” Thomas S. Metkus, MD, cardiologist and assistant professor of medicine at John Hopkins Hospital, and colleagues wrote in a simultaneous publication in the Journal of the American College of Cardiology. “Intraoperative TEE was associated with reduced mortality after adjustment for the higher patient risk profile. Although consideration of TEE for isolated CABG patients has been recommended by guidelines with a moderately strong recommendation, evidence that intraoperative TEE improves outcomes has been lacking.”
For this retrospective cohort study, researchers included 1,255,860 CABG procedures performed at 1,218 centers to evaluate the benefit of intraoperative TEE.
The primary exposure was use of TEE during CABG, and the primary outcome was 30-day mortality. Researchers also evaluated the relationship between TEE and unplanned valve surgery at the time of planned CABG.
Researchers reported that TEE was performed in 53.9% of all CABG procedures included in the analysis, and use increased from 39.9% in 2011 to 62.1% in 2019 (P for trend < .0001).
After adjustment, patients who underwent TEE during CABG had lower odds of 30-day mortality compared with those who did not (adjusted OR = 0.95; 95% CI, 0.91-0.99; P = .025).
Among the highest-risk patients, TEE was associated with lower odds of 30-day mortality (aOR = 0.89; 95% CI 0.83-0.95), but the same was not true in the lowest-risk group (aOR = 0.99; 95% CI, 0.94-1.04; P for interaction = .0147).
The researchers found TEE was associated with nearly a fivefold odds of an unplanned valve procedure at the time of planned CABG (aOR = 4.98; 95% CI, 3.98-6.22; P < .0001).
“Further studies are needed to assess the mechanism by which TEE may improve outcomes. These could include changes in the operative plan as we describe and also titration of vasoactives and changes in ICU post-op management. Standardized protocols for management of echo-related issues such as diastolic dysfunction should also be assessed,” Metkus told Healio. “Our results highlight opportunities to expand the reach of intra-operative imaging, which could improve CABG outcomes overall.”
Reference:
Collapse
Metkus TS, et al. Highlights in CV imaging: Echocardiography. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).
Click Here to Manage Email Alerts