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Ann Thorac Surg 1992;54:691-698
© 1992 The Society of Thoracic Surgeons

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Articles

The learing curve for intraoperative echocardiography during congenital heart surgery

Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

^_* Address reprint requests to Dr Ungerleider, Department of Surgery, Duke University Medical Center, Box 3178, Durham, NC 27710.

Our group has previously reported a large prospective experience with the use of intraoperative echocardiography with Doppler color-flow imaging (IE-DCFI) during the repair of congenital heart defects. We have now performed IE-DCFI in 621 patients and have observed a major change in the impact of this technology, which has stabilized during our most recent experience (the last 207 patients). To evaluate the surgical learning curve with IE-DCFI, we divided patients into three groups: group 1, patients 1 through 207; group 2, patients 208 through 414; and group 3, patients 415 through 621. There were no major differences between groups with respect to age or disease entities. The average time needed to perform an IE-DCFI examination decreased from 3.75 ± 1.77 minutes in group 1 to 3.35 ± 1.52 minutes in group 2 and has remained stable. The number of patients requiring revisions in the operating room (based on IE-DCFI findings) decreased from 17 (8%) in group 1 to 7 (3%) in group 2 to 5 (2%) in group 3. Furthermore, revisions were 100% successful in correcting the problem in groups 2 and 3, whereas 18% of group 1 patients left the operating room with persistent residual defects by IE-DCFI. Surgeons can acquire the ability to interpret the results of IE-DCFI themselves and use it to enhance their operative repair of congenital heart defects, but this requires an experience of at least 200 cases. Once skills are refined, the technique will identify 2% to 3% of patients who would benefit from operative revision before leaving the operating room and will direct that revision. As we learned to more accurately evaluate IE-DCFI data, the likelihood of a good outcome for patients leaving the operating room without IE-DCFI-identified problems improved from 88% in group 1 to 95% in group 2 to 97% in group 3.

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