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Intraoperative epicardial echocardiography or transoesophageal echocardiography in CHD: how much does it matter?
Katie J Stauffer1, Jerrid Brabender2, Charitha D Reddy1
1Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
Insights
Epicardial echocardiography shows similar diagnostic accuracy to transoesophageal echocardiography for congenital heart disease repairs. While not increasing imaging errors, it is associated with higher risks in higher-risk patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Intraoperative imaging is crucial for surgical repair integrity in congenital heart disease (CHD).
- Transoesophageal echocardiography (TOE) is the standard, but contraindications necessitate alternatives like epicardial echocardiography (ECHO).
- Limited data exists comparing the accuracy and outcomes of ECHO versus TOE.
Purpose of the Study:
- To evaluate the diagnostic accuracy of epicardial echocardiography compared to transoesophageal echocardiography in intraoperative CHD surgery.
- To hypothesize that epicardial echocardiography may have higher imaging error rates.
Main Methods:
- Retrospective review of 413 epicardial echocardiograms and 295 age/procedure-matched transoesophageal echocardiograms over 16 years.
- Comparison of intraoperative imaging discrepancies, re-operation rates, and patient outcomes.
- Statistical analysis using Wilcoxon two-sample and Fisher's exact tests.
Main Results:
- Similar rates of imaging discrepancies (13% ECHO vs. 16% TOE, p=0.2352), re-operations, and infections were observed.
- Epicardial echocardiography patients had smaller body sizes and more genetic abnormalities.
- Higher rates of death/mechanical support (16% vs. 6%) and longer hospitalizations (25 vs. 19 days) were noted in the ECHO group.
Conclusions:
- Epicardial echocardiography demonstrates comparable diagnostic accuracy to transoesophageal echocardiography.
- Increased mortality and need for mechanical support in the epicardial echocardiography group reflect a higher-risk patient population.
- Epicardial echocardiography is a viable alternative when transoesophageal echocardiography is not feasible for intraoperative CHD assessment.
Background:
Intraoperative imaging determines the integrity of surgical repairs. Transoesophageal echocardiography represents standard care for intraoperative imaging in CHD. However, some conditions preclude its use, and epicardial echocardiography is used alternatively. Minimal literature exists on the impact of epicardial echocardiography versus transoesophageal echocardiography. We aimed to evaluate accuracy between the two modalities and hypothesised higher imaging error rates for epicardial echocardiography.
Methods:
We retrospectively reviewed all epicardial echocardiograms performed over 16 years and compared them to an age- and procedure-matched, randomly selected transoesophageal echocardiography cohort. We detected un- or misidentified cardiac lesions during the intraoperative imaging and evaluated patient outcomes. Data are presented as a median with a range, or a number with percentages, with comparisons by Wilcoxon two-sample test and Fisher's exact test.
Results:
Totally, 413 patients comprised the epicardial echocardiography group with 295 transoesophageal echocardiography matches. Rates of imaging discrepancies, re-operation, and incision infection were similar. About 13% of epicardial echocardiography patients had imaging discrepancies versus 16% for transoesophageal (p = 0.2352), the former also had smaller body sizes (p < 0.0001) and more genetic abnormalities (33% versus 19%, p < 0.0001). Death/mechanical support occurred more frequently in epicardial echocardiography patients (16% versus 6%, p < 0.0001), while hospitalisations were longer (25 versus 19 days, p = 0.0003).
Conclusions:
Diagnostic accuracy was similar between patients undergoing epicardial echocardiography and transoesophageal echocardiography, while rates of death and mechanical support were increased in this inherently higher risk patient population. Epicardial echocardiography provides a reasonable alternative when transoesophageal echocardiography is not feasible.
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