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J Cardiothorac Vasc Anesth. 2012 Jun;26(3):371-5. doi: 10.1053/j.jvca.2012.02.005. Epub 2012 Mar 28.

Intraoperative changes in regional wall motion: can postoperative coronary artery bypass graft failure be predicted?

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  • 1Department of Anesthesiology, Montreal Heart Institute, University of Montréal, Montreal, Quebec, Canada.

Abstract

OBJECTIVE:

To evaluate the accuracy of new intraoperative regional wall motions abnormalities (RWMAs) detected by transesophageal echocardiography (TEE) to predict early postoperative coronary artery graft failure.

DESIGN:

A retrospective study.

SETTING:

A tertiary care university hospital.

PATIENTS:

Five thousand nine hundred ninety-eight patients who underwent coronary artery bypass graft (CABG) surgery.

INTERVENTIONS:

An evaluation of RWMAs recorded with intraoperative TEE before and after cardiopulmonary bypass (CPB) in patients who had coronary angiography for suspected postoperative myocardial ischemia based on electrocardiogram (ECG), CK-MB, troponin T, hemodynamic compromise, low cardiac output, and malignant ventricular arrhythmia. Sensitivity, specificity, positive and negative predictive values, odds ratio, 95% confidence interval, and chi-square analysis were used.

MEASUREMENTS AND MAIN RESULTS:

Thirty-nine patients (0.7%) underwent early coronary angiography for the suspicion of early graft dysfunction. Of the 32 patients with diagnosed early graft dysfunction, 5 patients (15.6%) had shown new intraoperative RWMAs as detected by TEE, 21 patients (65.6%) had no new RWMAs, no report was available in 5 patients (15.6%), and 1 examination (3.1%) was excluded because of poor imaging quality. The sensitivity of TEE to predict graft failure was 15.6%, the specificity was 57.1%, and the positive predictive and negative values were 62.5% and 12.9%, respectively. The odds ratio and 95% confidence interval was 0.1190 (0.0099-1.4257) when TEE was positive compared with coronary angiography. No association was found between new RWMAs detected with TEE and graft failure as documented with coronary angiography (p = 0.106).

CONCLUSIONS:

In this retrospective study, RWMAs detected with TEE were of limited value to predict early postoperative CABG failure.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
22459932
[PubMed - indexed for MEDLINE]
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