Background

Despite recommendations regarding the use of intraoperative transesophageal echocardiography (TEE), there is no randomized evidence to support its use in cardiac valve surgery. The purpose of this study was to compare the clinical outcomes of patients undergoing open cardiac valve repair or replacement surgery with and without transesophageal echocardiographic monitoring. The hypothesis was that transesophageal echocardiographic monitoring would be associated with lower 30-day mortality and shorter length of hospitalization.

Methods

In this observational retrospective cohort study, Medicare claims were used to test the association between perioperative TEE and 30-day all-cause mortality and length of hospitalization among patients undergoing open cardiac valve repair or replacement surgery between January 1, 2010, and October 1, 2015. Baseline characteristics were defined by inpatient and outpatient claims. Medicare death records were used to ascertain 30-day mortality. Statistical analyses included regression models and propensity score matching.

Results

A total of 219,238 patients underwent open cardiac valve surgery, of whom 85% underwent TEE. Patients who underwent TEE were significantly older and had greater comorbidities. After adjusting for patient demographics, clinical comorbidities, surgical characteristics, and hospital factors, including annual surgical volume, the TEE group had a lower adjusted odds of 30-day mortality (odds ratio, 0.77; 95% CI, 0.73 to 0.82; P < .001), with no difference in length of hospitalization (<0.01%; 95% CI, −0.61% to 0.62%; P = .99). Results were similar across all analyses, including a propensity score–matched cohort.

Conclusions

Transesophageal echocardiographic monitoring in cardiac valve repair or replacement surgery was associated with lower 30-day risk-adjusted mortality, without a significant increase in length of hospitalization. These findings support the use of TEE as routine practice in open cardiac valve repair or replacement surgery.

中文翻译：

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心脏瓣膜手术后经食道超声心动图、死亡率和住院时间。

背景

尽管建议使用术中经食管超声心动图 (TEE)，但没有随机证据支持其在心脏瓣膜手术中的使用。本研究的目的是比较接受和不接受经食道超声心动图监测的开放式心脏瓣膜修复或置换手术患者的临床结果。假设是经食道超声心动图监测与较低的 30 天死亡率和较短的住院时间有关。

方法

在这项观察性回顾性队列研究中，医疗保险索赔用于测试 2010 年 1 月 1 日至 10 月 1 日期间接受开放式心脏瓣膜修复或置换手术的患者围手术期 TEE 与 30 天全因死亡率和住院时间之间的关联， 2015. 基线特征由住院和门诊索赔定义。医疗保险死亡记录用于确定 30 天死亡率。统计分析包括回归模型和倾向评分匹配。

结果

共有 219,238 名患者接受了开放式心脏瓣膜手术，其中 85% 接受了 TEE。接受 TEE 的患者明显年龄更大，合并症更多。在调整患者人口统计学、临床合并症、手术特征和医院因素（包括年度手术量）后，TEE 组的 30 天死亡率调整后比值较低（比值比，0.77；95% CI，0.73 至 0.82；P  < .001)，住院时间没有差异（<0.01%；95% CI，-0.61% 至 0.62%；P  = .99）。所有分析的结果都相似，包括倾向评分匹配的队列。

结论

心脏瓣膜修复或置换手术中的经食道超声心动图监测与较低的 30 天风险调整死亡率相关，但住院时间没有显着增加。这些发现支持将 TEE 作为开放式心脏瓣膜修复或置换手术的常规做法。