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Intraoperative echocardiography during congenital heart operations: experience from 1,000 cases
R M Ungerleider1, J A Kisslo, W J Greeley
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27712, USA.
Insights
Intraoperative echocardiography aids in successful congenital heart defect repair by guiding revisions, improving outcomes. This technique, even with a learning curve, significantly reduces the need for costly reoperations.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Review of intraoperative echocardiography application in congenital heart defect (CHD) repair.
- Experience derived from 1,000 patient cases.
Purpose of the Study:
- To evaluate the utility of intraoperative echocardiography in guiding surgical revisions for CHD repair.
- To assess the impact of echocardiography on repair outcomes and hospital costs.
Main Methods:
- Retrospective analysis of 1,000 patients undergoing CHD repair (1987-1994).
- Intraoperative echocardiography (epicardial or transesophageal) performed pre- and post-repair.
- Collection of hospital costs and patient outcome data.
Main Results:
- 4.4% of patients required intraoperative revision based on echocardiography findings.
- Initial learning phase showed 8.5% revision rate, decreasing to 3-4% with experience.
- Surgeon's confidence did not predict need for revision; 2.6% of 'good' repairs required revision.
- Revision after discharge significantly increased costs compared to intraoperative revision.
- No complications attributed to intraoperative echocardiography.
Conclusions:
- Intraoperative echocardiography is crucial for achieving optimal surgical results in CHD repair.
- It provides essential information for guiding successful revisions, ensuring patients leave the OR with optimal outcomes.
- The technology aids in avoiding costly reoperations and improving patient care.
Background:
This article provides an overview of the application of intraoperative echocardiography during repair of congenital heart defects based on our experience with 1,000 patients.
Methods:
The patients in this study all underwent repair of a congenital heart defect between 1987 and 1994 at Duke University Medical Center. Echocardiography was performed on all patients in the operating room both before and after repair using epicardial or transesophageal imaging (or both). Hospital costs and outcome data were obtained for all patients.
Results:
Overall, 44 patients (4.4%) underwent intraoperative revision of their repair based on echocardiographic findings. There was an initial learning phase during which 8.5% of repairs needed to be revised. With experience, the number of revisions fell to as low as 3% to 4%, but need for revision continued to occur throughout the series. Thirty-nine patients (88.6%) had a successful revision. It was not possible for the surgeon to predict the need for a revision based on his confidence in the repair: in 2.6% of patients thought by the surgeon to have a good repair, intraoperative echocardiography revealed the need for operative revision. The average cost for patients who return to the operating room during their hospitalization for revision of a repair is significantly greater than for those whose repairs are revised before they leave the operating room ($94,180.28 +/- $33,881.63 versus $21,415.79 +/- $8,215.74). There were no significant complication attributable to intraoperative echocardiography.
Conclusions:
In an era where complete repair of congenital heart defects is emphasized, intraoperative echocardiography provides information that can guide successful operative revision so that babies leave the operating room with optimal results.