The fate of non-revisited transesophageal findings after cardiopulmonary bypass managed conservatively

• Published in: Journal of cardiothoracic and vascular anesthesia 2019-09, Vol.33, p.S116-S117
• Main Authors: Esteve, C. Ibanez, Rodríguez, G. Fita, Casado, M.J. Carretero, Dominguez, A. Carramiñana, Jimenez, P. Matute, Ripoll, R. Navarro, Gimenez, M.J. Arguis, Sancho, C. Gomar, Canudas, I. Rovira, Obrador, E. Quintana, Martinez, E. Sandoval, Pereda, D., Linares, J. Perdomo
• Format: Article
• Language: English
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2019.07.068

Transoesophageal echocardiography (TOE) use has experienced an exponential growth in cardiac surgery (CS). The latest guidelines recommend TOE for all adult patients undergoing CS, but the management of unexpected-TOE findings (ATOEF) after cardiopulmonary bypass (CPB) might be controversial. We reviewed the outcomes of those patients with ATOEF after CBP managed without immediate surgical revision. A systematic TOE use policy is applied in our institution for patients undergoing CS. Intraoperative TOE is performed by a senior anaesthesiologist. Data from intraoperative TOE cases were collected prospectively between January 2014 and December 2017. The presence of post-CPB ATOEF and its impact on the immediate surgical treatment decision-making was analysed. A total of 2421 TOE examinations were registered, with 197 post-CPB ATOEF. Among those with post-CPB ATOF, 108 (55%) led to immediate surgical treatment. The remaining 89 (45%) cases with post-CPB ATOEF did not received surgical treatment. These non-treated ATOEF were characterised into: 25 (28%) periprosthetic leak, 1 (1%) intraprosthetic regurgitation, 20 (22%) regurgitations after mitral valve (MV) repair, 11 (12%) regurgitations after aortic valve (AoV) repair, 7 (8%) and 2 (2%) regurgitations related to native MV and AoV respectively, 12 (13%) systolic anterior motion of the MV and 11 (12%) classified as other findings. The immediate postoperative follow-up showed the persistence of 36% of periprosthetic regurgitations, 100% of intraprosthetic regurgitations, 70% and 91% related to MV and AoV repair respectively, 86% and 100% related to native MV and AoV respectively. Two patients died in the immediate postoperative period and none required immediate re-do surgery due to the findings. The 6-12 month follow-up showed the persistence of 34% of periprosthetic leaks, 100% of intraprosthetic regurgitations, 70% and 91% of those related to MV and AoV repair, 71% and 100% of those related to native MV and AoV. Among all post-CPB ATOEF, 2 (2%) patients have required surgical treatment related to the finding in the long-term follow-up. Almost half of the post-CBP ATOEF did not lead to an immediate surgical treatment. Follow up echocardiography in the immediate postoperative period and at 6-12months, showed reduction of periprosthetic leaks. However, we observed stability of left-sided valve repair regurgitations. The incidence of reinterventions due to post-CBP ATOEF was low, reinforcing our current decisio