Nicholas A Haglund1, Simon Maltais2, Julian S Bick3, William Costello4, Mary Keebler1, Mary E Davis5, Nicole M Tricarico3, Chad E Wagner6. 1. Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN. 2. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN. 3. Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. 4. Anesthesiology and Critical Care, Vanderbilt University Medical Center, Nashville, TN. 5. Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN. 6. Cardiothoracic Anesthesiology and Critical Care, Vanderbilt University Medical Center, Nashville, TN. Electronic address: chad.e.wagner@vanderbilt.edu.
Abstract
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.
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-LVADpatients. 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-LVADpatients revealed that postoperative hTEE is used in sicker CF-LVADpatients and frequently leads to changes in ICU clinical management.
Authors: S Treskatsch; F Balzer; F Knebel; M Habicher; J P Braun; M Kastrup; H Grubitzsch; K-D Wernecke; C Spies; M Sander Journal: Int J Cardiovasc Imaging Date: 2015-06-06 Impact factor: 2.357
Authors: Duraid Younan; T Mark Beasley; David C Pigott; C Blayke Gibson; John P Gullett; Jeffrey Richey; Jean-Francois Pittet; Ahmed Zaky Journal: Crit Ultrasound J Date: 2017-10-11