Journal of cardiothoracic and vascular anesthesia | 2019
Practice Patterns for the Use of Perioperative Transesophageal Echocardiography: A Practice not yet Made Perfect.
Abstract
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) was introduced into clinical practice for cardiac surgery nearly 40 years ago, and guidelines pertaining to the anesthesiologist’s use of TEE were first published more than 20 years ago. Formalized training programs and standardized evaluation and testing before perioperative TEE board certification exist for physicians seeking specialization in TEE. Cardiac valve surgery is a component of cardiac surgical practice that often relies on the perioperative TEE examination for optimal outcomes; multiple “stakeholder” society groups, such as the American College of Cardiology, American Heart Association, American Society of Echocardiography, American Society of Anesthesiologists, Society of Cardiovascular Anesthesiology, and Society of Thoracic Surgeons, all have endorsed TEE use during valvular cardiac surgery. Recommended TEE use via guidelines, however, does not equate to pervasive, guaranteed TEE use in practice. In this edition of the Journal of Cardiothoracic and Vascular Anesthesia, MacKay et al. assessed the heterogeneity of intraoperative TEE use for open cardiac valve surgery in the United States between 2010 and 2015. The authors used a large proprietary database to identify nearly 20,000 insurance discharge claims that include both International Classification of Disease-9-Clinical Modification and Current Procedural Terminology codes for open mitral valve (MV) repair, open MV replacement, open aortic valve (AV) replacement, and combined open MV and AV surgeries. These discharge claims then were cross-examined for the presence or absence of an intraoperative TEE physician service claim. Interestingly, the authors found that only 82% of the open cardiac valve surgeries had a corresponding intraoperative TEE service claim. There was a small, albeit statistically significant, difference between the occurrence of intraoperative TEE claims for AV surgeries compared with MV or MV-AV surgeries (80% v 85%, respectively). The occurrence of intraoperative TEE claims did not improve over the prespecified time period