Vol. 44 | No. 2 | July-December 2016 Back

Open Access

The Role of Transesophageal Echocardiography in Decision-making During Surgical-based and Catheter-based Cardiac Procedures (TESCO): The Philippine Heart Center Experience

Cheryl K. Fomaneg, Melissa R. Cundangan, Maritoni G. Rapadas-Ilao, Shana Rizza B. Dumama-Remo, Edwin S. Tucay
Dec 2016 DOI 10.69944/pjc.db0d013103

Abstract

Introduction: Studies have shown that intraoperative transesophageal echocardiography (IOTEE) provides important information that may alter patient management and outcome in various cardiac surgeries. This is the first study to report our local experience on the clinical utility of IOTEE and the first paper to include patients who underwent percutaneous cardiac procedures. 

Objective: To determine the role of TEE in decision-making during cardiac procedures in our local setting. 

Methods: This is a retrospective cohort study involving 465 patients who underwent surgical- or catheter-based cardiac procedures with IOTEE at the Philippine Heart Center from January 2013 to December 2014. Differences in characteristics between patient groups pertaining to IOTEE findings were tested by Fisher’s exact test. 

Results: The most common indication for IOTEE in patients who underwent surgical-based procedures was assessment of valve lesion and its severity (83.11%), while guidance of catheter-based intracardiac procedure (100.00%) was the reason for catheter-based interventions. We identified 10.62% of new findings among patients with pre-operative TEE, commonly severe mitral regurgitation (20.33%); the occurrence was lower among patients with additional baseline TEE (p=0.400). Almost all of these new findings initiated alteration of procedures (10.40%). More than half (59.57%) of these procedures were extended and were mostly combination procedures like CABG + MV repair (17.86%). On the other hand, 15.60% of pertinent findings were detected in patients with post-operative TEE; 9.45% were related to the previously operated structure, while 6.15% pertained to other structures, and the most common finding was moderate tricuspid regurgitation. These findings initiated reoperation in 2.86% and repeat reoperation in 1.10%, with MVR as the leading reoperation procedure (33.33%). There were 11.65% findings that remained unoperated, most frequently moderate TR. The incidences of new findings (20.00% vs 10.41%; p=0.288) and alterations (20.00% vs 10.18%; p=0.279) were higher in patients with pre-operative TEE alone than those with pre-operative + post-operative TEEs. Also, the incidences of pertinent findings (23.08% vs 15.38%; p=0.437) and reoperations (15.38% vs 3.62%; p=0.089) were higher in patients with post-operative TEE alone than in patients with pre-operative + post-operative TEE. 

Conclusions: The role of TEE during surgical-based and catheter-based cardiac interventions remains substantial. Hence, it should be used routinely in patients undergoing cardiac procedures. 

Keywords: transesophageal echocardiography, decision-making, surgical- based cardiac procedures, catheter-based cardiac procedures.

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