Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery
Aims To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated. Methods and results In a 2-year study period...
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| Veröffentlicht in: | Clinical research in cardiology 2013-05, Vol.102 (5), p.351-359 |
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| creator | Buck, Thomas Kortmann, Kathrin Plicht, Björn Kamler, Markus Tsagakis, Konstantinos Thielmann, Matthias Jakob, Heinz G. Erbel, Raimund |
| description | Aims
To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated.
Methods and results
In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (
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| doi_str_mv | 10.1007/s00392-013-0544-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1326727328</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1326727328</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-42dc29ec24966edf5753d3ae5f4cb458eb326e2ca746b949982bffbe245e146f3</originalsourceid><addsrcrecordid>eNp1kc1q3DAYRUVJaH7aB-imCLrpxon-bNnLMqRtIJBNuhay9GlGyVhyJbswr9EnjhwnoRSy-iRxzpXQRegTJReUEHmZCeEdqwjlFamFqOQ7dErbhlak6djR67oVJ-gs53tCakq4eI9OGC9ezckp-rtJfvJG77EfxpgmHQzg6PAc8pxHMBNY7HywPmwztjCtJ_0B-zAlHUdIevJ_AJdNyJDjuNNbKGlgdtHoZH3cJj3uDtjFVHzjs48BD_qhBGI7p2U8cdrgPKctpMMHdOz0PsPH53mOfn2_utv8rG5uf1xvvt1Uhks2VYJZwzowTHRNA9bVsuaWa6idML2oW-g5a4AZLUXTd6LrWtY71wMTNVDROH6Ovq65Y4q_Z8iTGnw2sN_rAHHOihZfMslZW9Av_6H3cU6hvO6J4pxLvlB0pUyKOSdwakx-0OmgKFFLYWotTJXC1FKYksX5_Jw89wPYV-OloQKwFcjj8lmQ_rn6zdRHwbekmg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1326333738</pqid></control><display><type>article</type><title>Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Buck, Thomas ; Kortmann, Kathrin ; Plicht, Björn ; Kamler, Markus ; Tsagakis, Konstantinos ; Thielmann, Matthias ; Jakob, Heinz G. ; Erbel, Raimund</creator><creatorcontrib>Buck, Thomas ; Kortmann, Kathrin ; Plicht, Björn ; Kamler, Markus ; Tsagakis, Konstantinos ; Thielmann, Matthias ; Jakob, Heinz G. ; Erbel, Raimund</creatorcontrib><description>Aims
To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated.
Methods and results
In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (
p
< 0.05) of patients with both presurgical and postsurgical IOTEE.
Conclusion
We found an alarming high number of unsuspected pathologies by IOTEE causing substantial alterations of surgery. Beyond this, whether patients received presurgical IOTEE or not made a significant difference on the number of pathologies left unoperated.</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-013-0544-7</identifier><identifier>PMID: 23392530</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Aged ; Cardiac Surgical Procedures ; Cardiology ; Decision Support Techniques ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal ; Female ; Heart Valve Diseases - diagnostic imaging ; Heart Valve Diseases - surgery ; Humans ; Incidental Findings ; Intraoperative Care ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Paper ; Predictive Value of Tests ; Retrospective Studies</subject><ispartof>Clinical research in cardiology, 2013-05, Vol.102 (5), p.351-359</ispartof><rights>Springer-Verlag Berlin Heidelberg 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-42dc29ec24966edf5753d3ae5f4cb458eb326e2ca746b949982bffbe245e146f3</citedby><cites>FETCH-LOGICAL-c372t-42dc29ec24966edf5753d3ae5f4cb458eb326e2ca746b949982bffbe245e146f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-013-0544-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-013-0544-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23392530$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buck, Thomas</creatorcontrib><creatorcontrib>Kortmann, Kathrin</creatorcontrib><creatorcontrib>Plicht, Björn</creatorcontrib><creatorcontrib>Kamler, Markus</creatorcontrib><creatorcontrib>Tsagakis, Konstantinos</creatorcontrib><creatorcontrib>Thielmann, Matthias</creatorcontrib><creatorcontrib>Jakob, Heinz G.</creatorcontrib><creatorcontrib>Erbel, Raimund</creatorcontrib><title>Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Aims
To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated.
Methods and results
In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (
p
< 0.05) of patients with both presurgical and postsurgical IOTEE.
Conclusion
We found an alarming high number of unsuspected pathologies by IOTEE causing substantial alterations of surgery. Beyond this, whether patients received presurgical IOTEE or not made a significant difference on the number of pathologies left unoperated.</description><subject>Aged</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiology</subject><subject>Decision Support Techniques</subject><subject>Echocardiography, Doppler, Color</subject><subject>Echocardiography, Transesophageal</subject><subject>Female</subject><subject>Heart Valve Diseases - diagnostic imaging</subject><subject>Heart Valve Diseases - surgery</subject><subject>Humans</subject><subject>Incidental Findings</subject><subject>Intraoperative Care</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc1q3DAYRUVJaH7aB-imCLrpxon-bNnLMqRtIJBNuhay9GlGyVhyJbswr9EnjhwnoRSy-iRxzpXQRegTJReUEHmZCeEdqwjlFamFqOQ7dErbhlak6djR67oVJ-gs53tCakq4eI9OGC9ezckp-rtJfvJG77EfxpgmHQzg6PAc8pxHMBNY7HywPmwztjCtJ_0B-zAlHUdIevJ_AJdNyJDjuNNbKGlgdtHoZH3cJj3uDtjFVHzjs48BD_qhBGI7p2U8cdrgPKctpMMHdOz0PsPH53mOfn2_utv8rG5uf1xvvt1Uhks2VYJZwzowTHRNA9bVsuaWa6idML2oW-g5a4AZLUXTd6LrWtY71wMTNVDROH6Ovq65Y4q_Z8iTGnw2sN_rAHHOihZfMslZW9Av_6H3cU6hvO6J4pxLvlB0pUyKOSdwakx-0OmgKFFLYWotTJXC1FKYksX5_Jw89wPYV-OloQKwFcjj8lmQ_rn6zdRHwbekmg</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Buck, Thomas</creator><creator>Kortmann, Kathrin</creator><creator>Plicht, Björn</creator><creator>Kamler, Markus</creator><creator>Tsagakis, Konstantinos</creator><creator>Thielmann, Matthias</creator><creator>Jakob, Heinz G.</creator><creator>Erbel, Raimund</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery</title><author>Buck, Thomas ; 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To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated.
Methods and results
In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (
p
< 0.05) of patients with both presurgical and postsurgical IOTEE.
Conclusion
We found an alarming high number of unsuspected pathologies by IOTEE causing substantial alterations of surgery. Beyond this, whether patients received presurgical IOTEE or not made a significant difference on the number of pathologies left unoperated.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>23392530</pmid><doi>10.1007/s00392-013-0544-7</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Cardiac Surgical Procedures Cardiology Decision Support Techniques Echocardiography, Doppler, Color Echocardiography, Transesophageal Female Heart Valve Diseases - diagnostic imaging Heart Valve Diseases - surgery Humans Incidental Findings Intraoperative Care Male Medicine Medicine & Public Health Middle Aged Original Paper Predictive Value of Tests Retrospective Studies |
| title | Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery |
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