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Ann Thorac Surg 1997;64:368-373
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Intraoperative Echocardiography Is Indicated in High-Risk Coronary Artery Bypass Grafting

Robert M. Savage, MD, Bruce W. Lytle, MD, Solomon Aronson, MD, Jose L. Navia, MD, Michael Licina, MD, William J. Stewart, MD, Norman J. Starr, MD, Floyd D. Loop, MD

Departments of Cardiothoracic Anesthesia, Thoracic and Cardiovascular Surgery, and Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio

Background. Intraoperative echocardiography is a valuable monitoring and diagnostic technology used in cardiac surgery. This reports our clinical study of the usefulness of intraoperative echocardiography to both surgeons and anesthesiologists for high-risk coronary artery bypass grafting.

Methods. From March to November 1995, 82 consecutive high-risk patients undergoing coronary artery bypass grafting were studied in a four-stage protocol to determine the efficacy of intraoperative echocardiography in management planning. Alterations in surgical and anesthetic/hemodynamic management initiated by intraoperative echocardiography findings were documented in addition to perioperative morbidity and mortality.

Results. Intraoperative echocardiography initiated at least one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortality and the rate of myocardial infarction in this consecutive high-risk study population using intraoperative echocardiography and in a similar group of patients without the use of intraoperative echocardiography was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not significant), respectively.

Conclusions. We conclude that when all of the isolated diagnostic and monitoring applications of perioperative echocardiography are routinely and systematically performed together, it is a safe and viable tool that significantly affects the decision-making process in the intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients.


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Discussion
Ann. Thorac. Surg. 1997 64: 373-374. [Extract] [Full Text]



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