Transesophageal echocardiographic guidance of thoracic aortic stent-graft implantation

To evaluate the efficacy of intraoperative transesophageal echocardiography (TEE) as an adjunctive measure in guiding the implantation of endoluminal stent-grafts in the thoracic aorta.

TEE was used in 21 of 30 patients (27 men; median age 70 years; range 19-77) undergoing implantation of Excluder or Talent stent-grafts for management of 11 type B aortic dissections, 7 thoracic aortic aneurysms, 2 traumatic thoracic aortic ruptures, and an aortic coarctation. We evaluated the ability of TEE to provide evidence of (1) correct placement of the guidewire within the true lumen, (2) reduction in blood flow in the false lumen following stent deployment, and (3) early complications.

Definite identification of the true lumen and a reliable evaluation of the position of the stent-graft guidewire during advancement were possible in all patients. Reduction of blood flow within the false lumen following deployment of the stent-graft was visualized in >70% of patients with aortic dissection. In the patient with aortic coarctation, TEE recognized the acute onset of aortic dissection following stent dilation, which resulted in immediate management with an additional stent.

The intraoperative use of TEE in the implantation of stent-grafts in the thoracic aorta is not significantly invasive and is easily employed. It permits excellent evaluation of the correct placement of the stent guidewire and, in patients with aortic dissection, intraoperatively visualizes effective blood flow reduction in the false lumen following stent-graft deployment. Its ability to recognize early complications may indicate the need for additional maneuvers during the surgical procedure.