Objectives
To characterize existing practice patterns for intraoperative evaluation and grading
of diastolic dysfunction in patients undergoing cardiac surgery.
Design
A 14-question, multiple-choice survey of current practice for patients with diastolic
dysfunction and the use of intraoperative transesophageal echocardiography (TEE) to
evaluate, grade, and monitor changes in diastolic function.
Setting
Online survey.
Participants
Members of the Society of Cardiovascular Anesthesiologists.
Interventions
None.
Measurements and Main Results
Of 515 respondents, there was a near-even spread between those based in an academic
setting (53%) and those based in private practice (43%). Most respondents (81%) had
completed training with certification in TEE. Most respondents (86%) currently modified
their intraoperative management, at least some of the time, if they believed a patient
was experiencing diastolic dysfunction, with 72% varying the nature of any modification
according to the identified grade of diastolic dysfunction. Although 62% of respondents
usually evaluated diastolic dysfunction in the pre-bypass period, only 59% of those
evaluating diastolic dysfunction typically graded the dysfunction, with a variety
of algorithms used for this purpose. The majority of respondents (62%) typically did
not re-evaluate diastolic function using TEE in the post-bypass period. In 2 sample
patients with Doppler data provided, there was marked variation in grading of diastolic
dysfunction by respondents; this variation remained marked even within subgroups of
respondents who typically used the same grading algorithm.
Conclusions
Marked variation currently exists in how intraoperative TEE is used to evaluate, grade,
and monitor diastolic function during cardiac surgery. This suggests clinically important
knowledge gaps that should be addressed.
Key Words
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Article info
Publication history
Published online: January 19, 2016
Footnotes
This work was supported by intramural funding from the Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
