Automation Software for Transesophageal Echocardiography in Cardiac Patients: A Scoping Review

Automation software has improved accuracy, efficiency, and reproducibility in transthoracic echocardiography, but its role in transesophageal echocardiography (TEE) is less well established. Given rapid technological advances and heterogeneity among available tools, a comprehensive overview of current evidence is warranted. This scoping review aimed to map the literature on automation software for TEE in cardiac patients compared with manual measurements, summarize validation outcomes, and identify evidence gaps. The review was conducted according to the JBI Manual for Evidence Synthesis and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched (March 12, 2025; updated September 5, 2025), supplemented by trial registry searches and citation tracking. Eligible studies (published in 2020 or later) evaluated semi-automated or fully automated TEE software in adult patients and reported outcomes related to accuracy, efficiency, reproducibility, or feasibility. Data were synthesized descriptively. Ten studies met the inclusion criteria, addressing mitral (n = 4) and aortic valve assessment (n = 4), left atrial appendage measurements (n = 1), and automated Doppler tracing (n = 1). No studies evaluated automated left or right ventricular function. Agreement with manual TEE or external reference standards, including multidetector computed tomography and cardiac magnetic resonance imaging, was variable, with systematic differences frequently observed. Efficiency gains were inconsistent, while most studies demonstrated good reproducibility and feasibility. Overall, evidence on TEE automation remains heterogeneous. Although current tools show promising benefits, the evidence base is insufficient to support a future systematic review or definitive clinical recommendations. Substantial gaps persist, particularly in automated ventricular function assessment, highlighting the need for standardized validation and further research.