Advertisement

Hemodynamic Transesophageal Echocardiography After Left Ventricular Assist Device Implantation

Published:August 04, 2014DOI:https://doi.org/10.1053/j.jvca.2014.02.012

      Objective

      The authors hypothesized that the clinical profile of patients undergoing hTEE after continuous flow left ventricular assist device (CF-LVAD) implant would be in patients with greater acuity, more blood product utilization, and longer length of ICU stay, and that hTEE would change clinical management.

      Design

      Retrospective review.

      Setting

      University hospital.

      Participants

      One hundred consecutive patients receiving a CF-LVAD.

      Interventions

      Retrospective review using a standardized electronic form of a miniaturized disposable transesophageal echocardiography probe that documented not only physical findings but also changes in hemodynamic management (hTEE) in CF-LVAD patients.

      Measurements and Main Results

      Of the 100 patients, 41 received an hTEE probe. The INTERMACS score, Leitz-Miller Score, and Kormos score indicated the hTEE group had a statistically significant greater risk of morbidity and mortality. Interoperatively, the hTEE group received more blood products and was more likely to have an open chest. Postoperatively, the hTEE group received more blood products, had a longer total length of stay, and had increased mortality. ICU length of stay, days on inotropes and days on mechanical ventilation were not statistically significant between the 2 groups. Information obtained from hTEE changed ICU management in 72% of studies.

      Conclusion

      Retrospective review of CF-LVAD patients revealed that postoperative hTEE is used in sicker CF-LVAD patients and frequently leads to changes in ICU clinical management.

      KEY WORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kirklin J.K.
        • Naftel D.C.
        • Stevenson L.W.
        • et al.
        INTERMACS database for durable devices for circulatory support: First annual report.
        J Heart Lung Transplant. 2008; 27: 1065-1072
        • Kormos R.L.
        • Teuteberg J.J.
        • Pagani F.D.
        HeartMate II Clinical Investigators.
        J Thorac Cardiovasc Surg. 2010; 139: 1316-1324
        • Lietz K.
        • Long J.W.
        • Kfoury A.G.
        Circulation. 2007; 116: 497-505
        • Topilsky Y.
        • Hasin T.
        • Oh J.K.
        • et al.
        Echocardiographic variables after left ventricular assist device implantation associated with adverse outcome.
        Circ Cardiovasc Imaging. 2011; 4: 648-661
        • Jardin F.
        • Vieillard-Baron A.
        Monitoring of right-sided heart function.
        Curr Opin Crit Care. 2005; 11: 271-279
        • Wagner C.E.
        • Bick J.S.
        • Webster B.H.
        • et al.
        Use of a miniaturized transesophageal echocardiographic probe in the intensive care unit for diagnosis and treatment of a hemodynamically unstable patient after aortic valve replacement.
        J Cardiothorac Vasc Anesth. 2012; 26: 95-97
        • Maltais S.
        • Costello W.T.
        • Billings F.T.
        • et al.
        Episodic monoplane echocardiography impacts postoperative management of the cardiac surgery patient.
        J Cardiothorac Vasc Anesth. 2013; 27: 665-669
        • Cavarocchi N.C.
        • Pitcher H.T.
        • Yang Q.
        • et al.
        Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography.
        J Thorac Cardiovasc Surg. 2013; 146: 1474-1479
      1. Cioccari L, Baur HR, Berger D, et al: Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe. Crit Care 2013 Mar 27 [Epub ahead of print]

        • Vieillard-Baron A.
        • Slama M.
        • Mayo P.
        • et al.
        A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe.
        Intensive Care Med. 2013; 39: 629-635
      2. Mykytenko J, Levin R, Wagner CE: Right ventricular dysfunction in sepsis: Now you see it, now you don’t. ICU Director 3:135-138

        • Bick J.S.
        • McPherson J.A.
        • Schaff J.
        • et al.
        Initial experience with a disposable transesophageal echocardiography monitoring system during therapeutic hypothermia following out of hospital cardiac arrest.
        The Internet Journal of Emergency and Intensive Care Medicine. 2012; 2
        • Neragi-Miandoab S.
        • Goldstein D.
        • Bello R.
        • et al.
        Right ventricular dysfunction following continuous flow left ventricular assist device placement in 51 patients: Predictors and outcomes.
        J Cardiothorac Surg. 2012; 7: 60
        • Kormos R.L.
        • Teuteberg J.J.
        • Pagani F.D.
        • et al.
        Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes.
        J Thorac Cardiovasc Surg. 2010; 139: 1316-1324
        • Feldman D.
        • Pamboukian S.V.
        • Teuteberg J.J.
        • et al.
        The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: Executive summary.
        J Heart Lung Transplant. 2013; 32: 157-187
        • Slaughter M.S.
        • Pagani F.D.
        • Rogers J.G.
        • et al.
        Clinical management of continuous-flow left ventricular assist devices in advanced heart failure.
        J Heart Lung Transplant. 2010; 29: S1-S39