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Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery - 08/06/20

Doi : 10.1016/j.echo.2020.01.014 
Emily J. MacKay, DO, MS a, d, e, f, , Mark D. Neuman, MD, MS a, e, f, Lee A. Fleisher, MD, FACC, FAHA a, Prakash A. Patel, MD, FASE a, e, Jacob T. Gutsche, MD, FASE a, John G. Augoustides, MD, FASE a, Nimesh D. Desai, MD, PhD b, d, f, Peter W. Groeneveld, MD, MS c, d, f
a Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania 
b Division of Cardiovascular Surgery, Philadelphia, Pennsylvania 
c Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 
d Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania 
e Penn Center for Perioperative Outcomes Research and Transformation, Philadelphia, Pennsylvania 
f Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania 

Reprint requests: Emily J. MacKay, DO, MS, University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.University of Pennsylvania310 Blockley Hall, 423 Guardian DrivePhiladelphiaPA19104

Abstract

Background

Despite recommendations regarding the use of intraoperative transesophageal echocardiography (TEE), there is no randomized evidence to support its use in cardiac valve surgery. The purpose of this study was to compare the clinical outcomes of patients undergoing open cardiac valve repair or replacement surgery with and without transesophageal echocardiographic monitoring. The hypothesis was that transesophageal echocardiographic monitoring would be associated with lower 30-day mortality and shorter length of hospitalization.

Methods

In this observational retrospective cohort study, Medicare claims were used to test the association between perioperative TEE and 30-day all-cause mortality and length of hospitalization among patients undergoing open cardiac valve repair or replacement surgery between January 1, 2010, and October 1, 2015. Baseline characteristics were defined by inpatient and outpatient claims. Medicare death records were used to ascertain 30-day mortality. Statistical analyses included regression models and propensity score matching.

Results

A total of 219,238 patients underwent open cardiac valve surgery, of whom 85% underwent TEE. Patients who underwent TEE were significantly older and had greater comorbidities. After adjusting for patient demographics, clinical comorbidities, surgical characteristics, and hospital factors, including annual surgical volume, the TEE group had a lower adjusted odds of 30-day mortality (odds ratio, 0.77; 95% CI, 0.73 to 0.82; P < .001), with no difference in length of hospitalization (<0.01%; 95% CI, −0.61% to 0.62%; P = .99). Results were similar across all analyses, including a propensity score–matched cohort.

Conclusions

Transesophageal echocardiographic monitoring in cardiac valve repair or replacement surgery was associated with lower 30-day risk-adjusted mortality, without a significant increase in length of hospitalization. These findings support the use of TEE as routine practice in open cardiac valve repair or replacement surgery.

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Highlights

There is a lack of research on TEE in open cardiac valve surgery
TEE for open cardiac valve surgery is only an AHA class II recommendation
This study found that TEE was associated with lower 30-day, risk-adjusted mortality
This study found no difference in length of hospitalization with TEE vs without

Le texte complet de cet article est disponible en PDF.

Keywords : Transesophageal echocardiography, Cardiovascular surgery, Health services research, Comparative effectiveness research, Outcomes research

Abbreviations : CPT, OR, TEE


Plan


 This work was supported by a National Institutes of Health T-32 training grant (5T32HL098054) to Dr. MacKay.
 Conflicts of interest: None.


© 2020  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 33 - N° 6

P. 756 - juin 2020 Retour au numéro
Article précédent Article précédent
  • Adult Intraoperative Echocardiography: A Comprehensive Review of Current Practice
  • Jeremy J. Thaden, Joseph F. Malouf, Kent H. Rehfeldt, Elena Ashikhmina, Gabor Bagameri, Maurice Enriquez-Sarano, John M. Stulak, Hartzell V. Schaff, Hector I. Michelena
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  • The Natural and Unnatural History of Ventricular Septal Defects Presenting in Infancy: An Echocardiography-Based Review
  • Kelly Cox, Claudia Algaze-Yojay, Rajesh Punn, Norman Silverman

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