PURPOSE: Off-pump coronary artery bypass graft surgery (OPCAB) can improve operative morbidity and mortality in high risk patients. Intraoperative transesophageal echocardiography (TEE) is being employed increasingly during cardiac surgery.
METHODS: Routine intraoperative TEE was performed in 744 OPCAB patients performed over a 4 year period. Mean patient age was 69.1± 8.0 years. There were a high percentage of patients over 70 years (39%), diabetics (26%), poor left ventricular function (EF<30%) (31%), recent myocardial infarction (24%), unstable angina (15%) and preoperative intra-aortic balloon pump (IABP) (11%). Mean number of grafts were 3.4.
RESULTS: There was a major modification in intraoperative strategy in 117 patients (16 %) and minor modification in 77 patients (10%) due to information available through the intraoperative TEE (total 26%). Graft revision was performed in 39, graft construction was modified due to severe ascending aortic atherosclerotic changes in 31, intraoperative IABP was placed due to underappreciated left ventricular dysfunction prior to the procedure and new intraoperative LV dysfunction in 37 patients. Ten patients were placed on cardiopulmonary bypass due to previously unknown intracardiac pathology (3 atrial septal defect repair and 5 valvular procedures, 2 other). Intracoronary shunts were placed due to new wall motion changes during anastomosis in 77 patients. There were no complications due to TEE probe placement.
CONCLUSION: Intraoperative TEE is a valuable adjunct and can change surgical strategy in a significant number of patients when used routinely for OPCAB.
CLINICAL IMPLICATIONS: TEE may improve improve surgical outcomes and add to the benefits of OPCAB.
DISCLOSURE: Ahmet Gurbuz, None.