UTILITY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING PORT-ACCESS MINIMALLY INVASIVE CARDIAC-SURGERY

In this.study, we sought to determine the use of transesophageal echoc ardiography (TEE) as the primary imaging technique to assist in the pl acement of endovascular catheters during minimally invasive, port-acce ss cardiac surgery. The recent development of endovascular catheters t hat are placed via the femoral artery and vein has enabled patients to be placed on cardiopulmonary bypass without the need for direct visua lization of the heart or great vessels via sternotomy. This has allowe d cardiac surgery to be performed through smaller thoracotomy incision s. Placement of these catheters has previously been performed with flu oroscopic guidance, which has major imaging limitations. Thirty-six pa tients underwent port-access cardiac surgery at our institution during the study period. All patients underwent intraoperative TEE. We used TEE to visualize the coronary sinus os, right atrium and superior vena cava, and thoracic aorta to assist with placement of the coronary sin us catheter, venous cannula, and endoaortic clamp. Twenty patients und erwent mitral valve surgery, 14 patients coronary artery bypass grafti ng, 1 patient aortic valve replacement, and 1 patient repair of an atr ial septal defect by the port-access approach. TEE was able to adequat ely visualize the cardiac structures and assist in the placement of th e endovascular catheters in all patients. Fluoroscopy was only helpful as an aid to TEE for placement of the coronary sinus catheter. TEE is an excellent imaging modality for the proper placement of these new e ndovascular catheters, obviating the need for fluoroscopy, except to b e on standby and for placement of the coronary sinus catheter. (C) 199 8 by Excerpta Medica Inc.