The impact of routine trans-oesophageal echocardiography (TOE) in cardiac surgery

Trans-oesophageal echocardiography (TOE) has profoundly changed cardiac surgery and the role of the cardiac anaesthesiologist. It has been the driving force for a real-time diagnostic and decision-making partnership between cardiac anaesthesiologists and cardiac surgeons that has significantly advanced the safety and effectiveness of modern cardiac surgery. With the information provided by TOE, anaesthesiologists and surgeons may redirect the care of cardiac surgical patients to decrease morbidity and mortality. As a result, routine intra-operative TOE is an expectation in many cardiac surgical practices. While some colleagues continue to question whether TOE should be used routinely in all cardiac surgical patients, we believe that it is impossible to predict in which cardiac patients TOE will discover vitally important new information. Therefore, we recommend that in the absence of contraindication to oesophageal instrumentation with the probe, TOE should be performed in all cardiac surgical patients. With routine TOE use, TOE will have its greatest benefit.