Transesophageal Echocardiography for Cardiac Surgery

Introduction

Transesophageal echocardiography (TEE) for intraoperative planning is well established in the armamentarium of surgeons, cardiologists, and anesthesiologists. The use of intraoperative TEE has become the standard of care during cardiac surgery, and the intraoperative echocardiographer (IE), generally an anesthesiologist, has become an integral part of the cardiac surgery care team. This chapter will review the role of the IE and the intraoperative examination.

Role of the Intraoperative Echocardiographer

The IE is an integral part of the cardiac surgical team ( Box 49.1 ). The concept of an effective cardiac surgical team needs to emphasized. It is a group of individuals with an expressly agreed common goal who hold themselves mutually accountable for the outcome of the patient, which can depend enormously on how the team functions. Developing a culture of teamwork and effective communication has been shown to reduce mortality in the operative environment. Specifically in cardiac surgery, understanding the complex interactions during a cardiac surgical case likely improves patient safety and effective teamwork. The IE needs to develop an understanding of each team member in the cardiac operating room and their individual contribution to the overall success of the procedure at hand. This may be very different from other environments that they are typically used to working in outside the operating room.

The IE should be present during critical components of the operation to optimize their impact on the success of the procedure. The IE is a co-proceduralist, where a successful surgical outcome is dependent on their expert input, based on information obtained from the intraoperative TEE exam, and is communicated to the entire surgical team. As has been reported, information obtained from an intraoperative TEE exam has significant impact on anesthetic patient management, surgical planning, and patient outcomes. The primary objectives of the comprehensive intraoperative exam are to confirm the primary diagnosis and assess for any new pathophysiology, to discuss the exam, including its impact on anesthetic management, and to guide and assess the surgical outcome. The goal is an interdisciplinary plan of action at each stage of the operative procedure (precardiopulmonary bypass [CPB], during CPB, separation from CPB and post-CPB).