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CARDIOVASCULAR ANESTHESIA

Transesophageal Echocardiography for Monitoring Segmental Wall Motion During Off-Pump Coronary Artery Bypass Surgery

Jianwen Wang, MD^*, Miodrag Filipovic, MD^*, Ainars Rudzitis, MD, Isabelle Michaux, MD^*, Karl Skarvan, MD^*, Peter Buser, MD, Atanas Todorov, MD, Franziska Bernet, MD, and Manfred D. Seeberger, MD^*

Departments of *Anesthesia, Internal Medicine (Division of Cardiology), and Surgery (Division of Cardiothoracic Surgery), University of Basel, Basel, Switzerland

Address correspondence and reprint requests to Manfred D. Seeberger, MD, Department of Anesthesia, University of Basel, Kantonsspital, CH-4031 Basel, Switzerland. Address e-mail to mseeberger{at}uhbs.ch

In this prospective, observational study, we evaluated whether transesophageal echocardiography allows for monitoring left ventricular segmental wall motion during cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery. On the basis of a pilot study that showed frequent loss of transgastric views during OPCAB surgery, we analyzed only midesophageal views. The midesophageal 4-chamber view, 2-chamber view, and long-axis view were recorded in 60 patients after opening the chest and placing an epicardial stabilizer on the displaced heart. Using the 16-segment model, 2 echocardiographers independently performed offline analysis of segmental wall motion. The percentage of patients in whom 14 left ventricular segments were readable was calculated at baseline and after cardiac displacement and placement of an epicardial stabilizer. At baseline, 14 segments were readable in 59 (98%) of 60 patients. After cardiac displacement, 14 segments were readable during 58 (76%) of 76 revascularizations of the left anterior descending coronary artery (P < 0.01 versus baseline), during 33 (83%) of 40 revascularizations of the left circumflex coronary artery (P < 0.01 versus baseline), and during 29 (94%) of 31 revascularizations of the right coronary artery (not significant). We conclude that the number of readable segments decreased after cardiac displacement but that availability of 14 readable segments allowed for reliable monitoring of segmental wall motion in 4 of 5 patients during OPCAB surgery.

IMPLICATIONS: Our study found that transesophageal echocardiography provided reliable visualization of left ventricular segmental wall motion during off-pump coronary artery bypass surgery in most patients—a prerequisite for echocardiographic monitoring for ischemia. Future studies are needed to evaluate whether such monitoring improves patient outcome.

This article has been cited by other articles:

				A. T. Gurbuz, M. L. Hecht, and A. H. Arslan Intraoperative Transesophagial Echocardiography Modifies Strategy in Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., March 1, 2007; 83(3): 1035 - 1040. [Abstract] [Full Text] [PDF]

				I. Michaux, M. Filipovic, K. Skarvan, S. Schneiter, R. Schumann, H.-R. Zerkowski, F. Bernet, and M. D. Seeberger Effects of on-pump versus off-pump coronary artery bypass graft surgery on right ventricular function J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1281 - 1288. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999