Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

To determine the relative impact of each category-based TEE indication according to the ASA guidelines. In 851 patients undergoing cardiac surgery, TEE clinical indications were classified as category I or II according to the ASA guidelines. Category I indications are patients in which TEE is considered useful and category II are those where TEE is potentially useful but indications are less clear. All TEE examinations were reviewed by two anesthesiologists with advanced training in TEE. For each patient, the clinical impact of TEE in the clinical management was assessed using five criteria: 1) change of medical therapy; 2) change in the surgical procedure; 3) confirmation of a suspected diagnosis; 4) positioning of an intravascular device, and 5) substitute to a pulmonary artery catheter (PAC). TEE had greater utility in category I than in category II indications (15/53 (28%) vs. 110/798 (14%) respectively) (P