Surgical Volume and Outcomes of Intraoperative Transesophageal Echocardiography in Coronary Artery Bypass Grafting

Among patients undergoing isolated coronary artery bypass grafting (CABG), which subgroups derive the greatest survival benefit from intraoperative transesophageal echocardiography (TEE), and does this benefit vary by hospital surgical volume?In this cohort study of 1.26 million patients who underwent isolated CABG, intraoperative TEE was associated with survival benefits at low and medium surgical volume hospitals, particularly among patients with greater than 50% left-main coronary stenosis, 3 or more diseased vessels, or preoperative inotrope use. No survival benefit was observed at high surgical volume hospitals.These findings support a more individualized approach to TEE use during isolated CABG surgery and provide a rationale for future randomized evaluation.

Corresponding Author: Emily J. MacKay, DO, MS, University of Pennsylvania, 423 Guardian Dr, 310 Blockley Hall, Philadelphia, PA 19104 (emily.mackay@pennmedicine.upenn.edu).

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