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Canadian Journal of Anesthesia 47:20-26 (2000)
© Canadian Anesthesiologists' Society, 2000
Reports of Investigation

Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

Pierre Couture, MD FRCPC*, André Y. Denault, MD FRCPC*, Sylvie McKenty, MD FRCPC*, Daniel Boudreault, MD FRCPC*, François Plante, MD FRCPC*, Roger Perron, Rrt*, Denis Babin, MSc*, Louis Normandin, MD Frcsc{dagger} and Normand Poirier, MD Frcsc{dagger}

* From the Departments of Anesthesiology and
{dagger} Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Campus NotreDame, Montréal, Québec, Canada.

Address correspondence to: Dr. P. Couture, Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec, Canada, H1T 1C8. Phone: 514-376-3330 Ext: 3732; Fax: 514-376-8784; E-mail: p.couture{at}sympatico.ca.

Objectif : Déterminer l'effet relatif de l'indication de l'ETO basée sur chacune des catégories relevant des recommandations ASA.

Méthode : Chez 851 patients devant subir une intervention chirurgicale cardiaque, les indications cliniques de l'ETO ont été classées en catégorie I ou II selon les recommandations de l'ASA. Dans la catégorie I, ce sont les patients pour qui l'ETO est considérée utile et dans la catégorie II, ceux pour qui l'ETO est probablement utile, les indications n'étant pas aussi claires. Tous les examens d'ETO ont été révisés par deux anesthésiologistes de formation poussée en ETO. Les répercussions cliniques de l'ETO sur le traitement clinique de chaque patient ont été évaluées selon cinq critères: 1) la modification du traitement médical 2) un changement de technique chirurgicale 3) la confirmation d'un diagnostic présumé 4) la mise en place d'un appareil intravasculaire 5) un substitut au cathéter de l'artère pulmonaire (CAP).

Résultats : L'ETO a présenté une plus grande utilité avec les indications de catégorie I qu'avec celles de catégorie II (15/53 (28 %) vs 110/798 (14 %) respectivement) (P < 0,01). La nature de l'effet clinique a été : une modification de traitement médical chez 67/125 (53 %), un changement d'intervention chirurgicale chez 38/125 (30 %), la confirmation d'un diagnostic chez 34/125 (27 %). Les conséquences sur le traitement ont été plus grandes pour des interventions chirurgicales complexes (39 %) que pour le remplacement valvulaire (19 %) (P < 0,01) et le pontage aortocoronarien (10 %) (P < 0,001).

Conclusion : Nos résultats confirment l'utilité des recommandations de pratique de l'ASA qui démontrent une plus grande influence de l'ETO sur le traitement clinique pour les indications de catégorie I que pour celles de catégorie II. L'ETO a aussi un effet plus important sur les interventions chirurgicales complexes et sur le remplacement valvulaire.




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This Article
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