Original ArticleTransesophageal Echocardiography Guidance of Antegrade Cardioplegia Delivery for Cardiac Surgery
Section snippets
Methods
This prospective cohort study received ethics approval from the Monash Health (12399Q) and Melbourne Health (QA2013047) Human Research Ethics Committees as a quality assurance project, and patient consent was not required. Patients were screened when the primary investigator was available (convenience sampling) from consecutive patients older than 18 years presenting for cardiac surgery requiring cardiopulmonary bypass (CPB) and myocardial protection during aortic cross-clamping with antegrade
Statistical Analysis
The estimated sample size of 60 patients was based on unpublished data from a pilot study. In the pilot study, a moderate correlation (r = 0.67) between estimated LV mass and volume of cardioplegia required for asystole was found by a single observer in 14 consecutive patients undergoing CABG surgery without detectable AR. Using an estimated incidence of at least trivial AR in cardiac surgical patients of 33%, this would require 21 patients to enroll 14 patients without AR. However, in the
Results
Out of 60 patients recruited between December 2012 and February 2014, 2 patients were excluded, leaving 58 patients with data for analysis. One patient was excluded due to inadequate echocardiography imaging (no transgastric views), and another patient was excluded as the surgery was performed without cardioplegia. Patient characteristics and surgical data are shown in Table 1.
Aortic regurgitation (of any severity) was detected in 19 patients who were excluded from the correlation analysis of
Discussion
The authors’ study showed that the estimation of LV mass by intraoperative TEE was not clinically useful for estimating the amount of initial volume of antegrade cardioplegia required to achieve asystole. However, it was shown that TEE was useful for routine monitoring for left ventricular distention during antegrade cardioplegia delivery as excessive LV distention was common, requiring conversion to retrograde delivery to achieve asystole in a quarter of patients and occurs in nearly 20% of
Acknowledgments
The authors are grateful for the assistance from the cardiac surgeons, anesthetists, and clinical perfusionists at Monash Medical Centre and The Royal Melbourne Hospital who assisted with data collection. They also thank Sandy Clarke and Darsim Haji for statistical advice. There was no funding provided or competing interests declared.
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