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Intraoperative echocardiography is indicated in high-risk coronary artery bypass grafting
R M Savage1, B W Lytle, S Aronson
1Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Intraoperative echocardiography significantly influences surgical and anesthetic decisions in high-risk coronary artery bypass grafting patients. This valuable tool aids in optimal patient care during complex cardiac procedures.
Area of Science:
- Cardiology
- Anesthesiology
- Surgical Technology
Background:
- Intraoperative echocardiography is a key diagnostic and monitoring tool in cardiac surgery.
- Its utility for surgeons and anesthesiologists in high-risk coronary artery bypass grafting (CABG) was evaluated.
Purpose of the Study:
- To assess the efficacy of intraoperative echocardiography in guiding management decisions for high-risk CABG patients.
- To document changes in surgical and anesthetic management based on echocardiographic findings.
Main Methods:
- A study of 82 high-risk CABG patients from March to November 1995.
- A four-stage protocol was used to evaluate intraoperative echocardiography's impact on management.
- Perioperative morbidity and mortality were recorded.
Main Results:
- Echocardiography led to major surgical management changes in 33% of patients and anesthetic/hemodynamic changes in 51%.
- Mortality rates were 1.2% with echocardiography versus 3.8% without (not significant).
- Myocardial infarction rates were 1.2% with echocardiography versus 3.5% without (not significant).
Conclusions:
- Routine, systematic use of intraoperative echocardiography is safe and effective in high-risk CABG surgery.
- It significantly impacts decision-making, potentially optimizing patient care.
- Perioperative echocardiography is a viable tool for complex cardiac procedures.
Background:
Intraoperative echocardiography is a valuable monitoring and diagnostic technology used in cardiac surgery. This reports our clinical study of the usefulness of intraoperative echocardiography to both surgeons and anesthesiologists for high-risk coronary artery bypass grafting.
Methods:
From March to November 1995, 82 consecutive high-risk patients undergoing coronary artery bypass grafting were studied in a four-stage protocol to determine the efficacy of intraoperative echocardiography in management planning. Alterations in surgical and anesthetic/hemodynamic management initiated by intraoperative echocardiography findings were documented in addition to perioperative morbidity and mortality.
Results:
Intraoperative echocardiography initiated at least one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortality and the rate of myocardial infarction in this consecutive high-risk study population using intraoperative echocardiography and in a similar group of patients without the use of intraoperative echocardiography was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not significant), respectively.
Conclusions:
We conclude that when all of the isolated diagnostic and monitoring applications of perioperative echocardiography are routinely and systematically performed together, it is a safe and viable tool that significantly affects the decision-making process in the intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients.