Importance of intraoperative transesophageal echocardiography during coronary artery surgery without cardiopulmonary bypass

The goal of this study was to assess left ventricular segmental wall motion (SWM) abnormalities during coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), and its impact on the immediate postoperative outcome. Transesophageal echocardiography was used intraoperatively in 27 patients (mean age 57 years) who had CABG without CPB. Images obtained with a 5-MHz biplane transesophageal echocardiographic probe in the transgastri c and transesophageal planes were recorded before, during, and after 48 cor onary artery clampings for saphenous vein or internal mammary artery anasto mosis. Transthoracic echocardiography was performed 1 day before surgery an d on the seventh postoperative day. During the 48 coronary artery clamplngs , 31 (64%) new SWM abnormalities were found. At the time of chest closure, complete recovery occurred in 16 (50%) segments, partial recovery in 10 (33 %), and no recovery in 5 (17%). On the seventh postoperative day the flew S W abnormalities persisted in all 5 segments without recovery at the end of the surgery and in 2 of 10 (20%)segments with partial recovery(group 1). Gr oup 1 had higher variation on the echocardiographic point score index betwe en the beginning and end of surgery, higher enzymatic levels, more ST-T cha nges on the electrocardiogram, and more clinical problems than group 2 (pat ients without new SWM abnormalities on the seventh postoperative day) (P < .05). We concluded that flew SWM abnormalities of the left ventricle occur during CABG without CPB as assessed by intraoperative transesophageal echoc ardiography. Persistence of these abnormalities at the end of surgery may b e a predictor of SWM dysfunction and clinical problems in the immediate pos toperative period.