Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery.
Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery.
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DOI：
10.1016/j.jacc.2021.04.064
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发表时间：
2021-07-13
影响因子：
24
通讯作者：
Higgins R
中科院分区：
文献类型：
--
作者：
Metkus TS;Thibault D;Grant MC;Badhwar V;Jacobs JP;Lawton J;O'Brien SM;Thourani V;Wegermann ZK;Zwischenberger B;Higgins R
在孤立性冠状动脉旁路移植术（CABG）时使用术中经食管超声心动图（TEE）对临床决策和相关结局的影响尚不清楚。本研究的目的是确定TEE与CABG术后死亡率和手术计划变更的相关性。对2011年1月1日至2019年6月30日期间胸外科医师协会成人心脏手术数据库中计划的孤立CABG患者进行了一项回顾性队列研究。关注的暴露变量是CABG期间使用术中TEE与不使用TEE的比较。主要结局为手术死亡率。还评估了TEE与计划外瓣膜手术的相关性。在1218家临床试验机构的1，255，860例计划的单独CABG手术中，676，803例（53.9%）进行了术中TEE。接受术中TEE的患者比例随时间推移从2011年的39.9%增加至2019年的62.1%（p趋势<0.0001）。接受术中TEE的CABG患者的死亡率较低（调整后的比值比：0.95; 95%置信区间：0.91 - 0.99; p = 0.025），STS风险组间存在异质性（p相互作用= 0.015）。TEE与计划外瓣膜手术代替计划的单独CABG的几率增加相关（调整后的比值比：4.98; 95%置信区间：3.98 - 6.22; p < 0.0001）。在计划的孤立CABG期间术中使用TEE与较低的手术死亡率相关，特别是在高风险患者中，以及计划外瓣膜手术的可能性更大。这些发现支持使用TEE来改善高危患者孤立CABG的结局。
The impact of utilization of intraoperative transesophageal echocardiography (TEE) at the time of isolated coronary artery bypass grafting (CABG) on clinical decision making and associated outcomes is not well understood. The purpose of this study was to determine the association of TEE with post-CABG mortality and changes to the operative plan. A retrospective cohort study of planned isolated CABG patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database between January 1, 2011, and June 30, 2019, was performed. The exposure variable of interest was use of intraoperative TEE during CABG compared with no TEE. The primary outcome was operative mortality. The association of TEE with unplanned valve surgery was also assessed. Of 1,255,860 planned isolated CABG procedures across 1218 centers, 676,803 (53.9%) had intraoperative TEE. The proportion of patients receiving intraoperative TEE increased over time from 39.9% in 2011 to 62.1% in 2019 (p trend <0.0001). CABG patients undergoing intraoperative TEE had lower odds of mortality (adjusted odds ratio: 0.95; 95% confidence interval: 0.91 to 0.99; p = 0.025), with heterogeneity across STS risk groups (p interaction = 0.015). TEE was associated with increased odds of unplanned valve procedure in lieu of planned isolated CABG (adjusted odds ratio: 4.98; 95% confidence interval: 3.98 to 6.22; p < 0.0001). Intraoperative TEE usage during planned isolated CABG is associated with lower operative mortality, particularly in higher-risk patients, as well as greater odds of unplanned valve procedure. These findings support usage of TEE to improve outcomes for isolated CABG for high-risk patients.
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DOI：
10.1016/j.echo.2013.07.009
发表时间：
2013-09-01
影响因子：
6.5
作者：
Hahn, Rebecca T.;Abraham, Theodore;Picard, Michael H.
通讯作者：
Picard, Michael H.
DOI：
10.1016/j.echo.2020.03.002
发表时间：
2020-05-01
影响因子：
6.5
作者：
Nicoara, Alina;Skubas, Nikolaos;Swaminathan, Madhav
通讯作者：
Swaminathan, Madhav
DOI：
10.1016/j.echo.2020.01.014
发表时间：
2020-05-01
影响因子：
6.5
作者：
MacKay, Emily J.;Neuman, Mark D.;Groeneveld, Peter W.
通讯作者：
Groeneveld, Peter W.
影响因子：
4.6
作者：
Hannan, Edward L.;Samadashvili, Zaza;Kurlansky, Paul A.
通讯作者：
Kurlansky, Paul A.
DOI：
10.1016/j.jtcvs.2012.11.094
发表时间：
2013-04-01
影响因子：
6
作者：
Jacobs, Jeffrey P.;O'Brien, Sean M.;Grover, Frederick L.
通讯作者：
Grover, Frederick L.