Impact of intraoperative transesophageal echocardiography among patients undergoing aortic valve replacement for aortic stenosis.

In this study, we sought to define the impact of intraoperative transesophageal echocardiography (IOTEE) among patients undergoing aortic valve replacement for severe aortic stenosis. We reviewed the clinical data and preoperative, intraoperative, and postoperative echocardiograms of all adults who underwent aortic valve replacement for aortic stenosis and had IOTEE between January 1993 and December 1996. There were 383 patients (223 men, 160 women; mean age, 69 years). Fifty-four (14%) of the 383 patients had mitral valve surgery at the time of aortic valve replacement. In 6 patients, mitral valve surgery was not planned but was added because of findings on IOTEE. In 25 patients, mitral valve surgery was canceled on the basis of the IOTEE. Additional information was found by IOTEE in 25 patients before and after bypass, altering the surgical plan in 18 of these 25 patients. Overall, IOTEE altered the planned operation in 49 (13%) of the 383 patients. These data support the routine use of IOTEE among patients undergoing aortic valve replacement for aortic stenosis.