Intraoperative transesophageal echocardiography (TEE) boosts clinical outcomes for patients undergoing cardiac valve or proximal aortic surgery, according to a new analysis published in JAMA Network Open.[1]
Evidence on the potential impact of intraoperative TEE is growing, the study’s authors noted, but cardiac valve repair, cardiac valve replacement and proximal aortic surgery are three key areas where additional data is still needed. The group turned to the Society of Thoracic Surgeons Adult Cardiac Surgery Database to learn more.
“These STS data allowed the application of rigorous statistical matching techniques to directly compare similar patients who underwent cardiac valve or proximal aortic surgery with vs. without intraoperative TEE,” wrote first author Emily J. Mackay, DO, MS, with the department of anesthesiology and critical care at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues. “We hypothesized that intraoperative TEE would be associated with a decreased incidence of 30-day mortality, stroke or 30-day mortality, and reoperation or 30-day mortality.”
Mackay et al. focused on data from nearly 873,000 adult patients. All patients underwent valve or aortic surgery from July 2011 to June 2019. Patients undergoing isolated coronary artery bypass graft surgery or an unspecified valve or aortic surgery were excluded. While 81.5% of patients underwent intraoperative TEE, the remaining patients did not. The mean patient age was 66 years old, 62% of patients were male and 85% were white.
Overall, the 30-day mortality rate was 4.32%. The rate was significantly lower among patients who underwent intraoperative TEE (3.92%) than those who did not (5.27%). The rates of stroke/30-day mortality and reoperation/30-day mortality were also lower for the intraoperative TEE patients. A matched analysis using data from more than 161,000 matched pairs led to the same conclusions: consistently better outcomes among patients who underwent intraoperative TEE.
“These findings provide evidence to support the routine use of intraoperative TEE in all open cardiac valve and proximal aortic surgical procedures,” the authors concluded.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.