Intraoperative transesophageal echocardiography and ventricular assist device insertion

A decade after cardiac surgery was established, transesophageal echocardiography (TEE) was developed and used to evaluate perioperative cardiac performance. It has become an invaluable tool to provide real-time information in the cardiac operating room. TEE provides practical and useful information prior to insertion as well as after placement of the device. Additionally, during episodes of device malfunction or hemodynamic instability, TEE can be extremely useful in defining the etiology of the problem. As ventricular assist devices (VADs) have undergone evolution in design and as more VADs are being implanted, the development of specific indications for TEE use during device placement is a relevant issue. Formal guidelines for use of TEE during VAD insertion are yet to be adopted or implemented, but for now TEE remains an essential tool for managing this patient population.