INTRAOPERATIVE ECHOCARDIOGRAPHY IS INDICATED IN HIGH-RISK CORONARY-ARTERY BYPASS-GRAFTING

Background. Intraoperative echocardiography is a valuable monitoring a nd diagnostic technology used in cardiac surgery. This reports our cli nical study of the usefulness of intraoperative echocardiography to bo th surgeons and anesthesiologists for high-risk coronary artery bypass grafting. Methods. From March to November 1995, 82 consecutive high-r isk patients undergoing coronary artery bypass grafting were studied i n a four-stage protocol to determine the efficacy of intraoperative ec hocardiography in management planning. Alterations in surgical and ane sthetic/hemodynamic management initiated by intraoperative echocardiog raphy findings were documented in addition to perioperative morbidity and mortality. Results. Intraoperative echocardiography initiated at l east one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortali ty and the rate of myocardial infarction in this consecutive high-risk study population using intraoperative echocardiography and in a simil ar group of patients without the use of intraoperative echocardiograph y was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not sig nificant), respectively. Conclusions. We conclude that when all of the isolated diagnostic and monitoring applications of perioperative echo cardiography are routinely and systematically performed together, it i s a safe and viable tool that significantly affects the decision-makin g process in the intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients. (C) 1997 by The Society of Thorac ic Surgeons.