ARTICLE: Utilization and outcomes of transesophageal echocardiography in 1.3 million CABG procedures

AUTHORS: Thomas S Metkus, Dylan Thibault, Michael C Grant, Vinay Badhwar, Jeffrey P Jacobs, Jennifer Lawton, Sean M O'Brien, Vinod Thourani, Zachary K Wegermann, Brittany Zwischenberger, Robert Higgins

JOURNAL: J Am Coll Cardiol. 2021 Apr 28;S0735-1097(21)04930-5. doi: 10.1016/j.jacc.2021.04.064. Online ahead of print.

Abstract

Background: Utilization of intraoperative transesophageal echocardiography (TEE) at time of isolated coronary artery bypass grafting (CABG), impact on clinical decision making and associated outcomes are not well understood.

Objective: To determine the association of TEE with post-CABG mortality and changes to the operative plan.

Methods: We performed a retrospective cohort study of planned isolated CABG patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database between January 1, 2011 and June 30, 2019. The exposure variable of interest was use of intraoperative TEE during CABG, compared to no TEE. The primary outcome was operative mortality. We also assessed the association of TEE with unplanned valve surgery.

Results: Of 1,255,860 planned isolated CABG procedures across 1218 centers, 676,803 (53.9%) had intra-operative TEE. The proportion of patients receiving intra-operative TEE increased over time from 39.9% in 2011 to 62.1% in 2019 (Ptrend<0.0001). CABG patients undergoing intra-operative TEE had lower odds of mortality (adjusted OR 0.95, 95% CI 0.91-0.99, P=0.025), with heterogeneity across STS risk groups (Pinteraction 0.015). TEE was associated with increased odds of unplanned valve procedure in lieu of planned isolated CABG (adjusted OR 4.98, 95% CI 3.98-6.22, P<0.0001) CONCLUSION: Intra-operative TEE usage during planned isolated CABG is associated with lower operative mortality, particularly in higher risk patients, as well as greater odds of unplanned valve procedure. Our findings support usage of TEE to improve outcomes for isolated CABG for high risk patients.

Keywords: Cardiac surgery; Coronary artery bypass grafting; Echocardiography; Transesophageal echocardiography.

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