Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD

Erin Madriago, Rajesh Punn, Natalie Geeter, Norman H. Silverman

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. Methods We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings. Results The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. Conclusions This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.

Original languageEnglish (US)
Pages (from-to)263-268
Number of pages6
JournalCardiology in the Young
Volume26
Issue number2
DOIs
StatePublished - Feb 9 2015

Fingerprint

Echocardiography
Length of Stay
Pulmonary Valve
Tricuspid Valve
Operating Rooms
Mitral Valve
Lung Diseases
Morbidity
Mortality

Keywords

  • cardiopulmonary bypass
  • pediatric imaging
  • Residual abnormalities

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD. / Madriago, Erin; Punn, Rajesh; Geeter, Natalie; Silverman, Norman H.

In: Cardiology in the Young, Vol. 26, No. 2, 09.02.2015, p. 263-268.

Research output: Contribution to journalArticle

Madriago, Erin ; Punn, Rajesh ; Geeter, Natalie ; Silverman, Norman H. / Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD. In: Cardiology in the Young. 2015 ; Vol. 26, No. 2. pp. 263-268.
@article{c07c1e05b0314af1b06604c7d276cf46,
title = "Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD",
abstract = "Objectives Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. Methods We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7{\%}) that required return to bypass, based in part upon the intra-operative echocardiographic findings. Results The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9{\%}), tricuspid valve disease (16.0{\%}), atrioventricular canal defects (12.0{\%}), and pulmonary valve disease (14.1{\%}). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8{\%}) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. Conclusions This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.",
keywords = "cardiopulmonary bypass, pediatric imaging, Residual abnormalities",
author = "Erin Madriago and Rajesh Punn and Natalie Geeter and Silverman, {Norman H.}",
year = "2015",
month = "2",
day = "9",
doi = "10.1017/S1047951115000098",
language = "English (US)",
volume = "26",
pages = "263--268",
journal = "Cardiology in the Young",
issn = "1047-9511",
publisher = "Cambridge University Press",
number = "2",

}

TY - JOUR

T1 - Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD

AU - Madriago, Erin

AU - Punn, Rajesh

AU - Geeter, Natalie

AU - Silverman, Norman H.

PY - 2015/2/9

Y1 - 2015/2/9

N2 - Objectives Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. Methods We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings. Results The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. Conclusions This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.

AB - Objectives Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. Methods We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings. Results The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. Conclusions This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.

KW - cardiopulmonary bypass

KW - pediatric imaging

KW - Residual abnormalities

UR - http://www.scopus.com/inward/record.url?scp=84955193456&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955193456&partnerID=8YFLogxK

U2 - 10.1017/S1047951115000098

DO - 10.1017/S1047951115000098

M3 - Article

C2 - 25730612

AN - SCOPUS:84955193456

VL - 26

SP - 263

EP - 268

JO - Cardiology in the Young

JF - Cardiology in the Young

SN - 1047-9511

IS - 2

ER -