Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study

Wouter W. Jansen Klomp*, Carl G.M. Moons, Arno P. Nierich, George J. Brandon Bravo Bruinsma, Arnoud W.J. van 't Hof, Jan G. Grandjean, Linda M. Peelen

*Corresponding author for this work

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    Abstract

    The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p<0.001) and more often females (31.0% versus 28.0%, p<0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p<0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50-1.00, p=0.05) and 0.67 (95% CI: 0.45-0.98, p=0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73-1.45) and 1.01 (95% CI: 0.71-1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.

    Original languageEnglish
    Article number1857069
    JournalInternational journal of vascular medicine
    Volume2017
    DOIs
    Publication statusPublished - 2017

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    Transesophageal Echocardiography
    Thoracic Surgery
    Cohort Studies
    Stroke
    Mortality
    Propensity Score
    Hospital Mortality
    Atherosclerosis
    Control Groups
    Incidence

    Cite this

    Jansen Klomp, W. W., Moons, C. G. M., Nierich, A. P., Brandon Bravo Bruinsma, G. J., van 't Hof, A. W. J., Grandjean, J. G., & Peelen, L. M. (2017). Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study. International journal of vascular medicine, 2017, [1857069]. https://doi.org/10.1155/2017/1857069
    Jansen Klomp, Wouter W. ; Moons, Carl G.M. ; Nierich, Arno P. ; Brandon Bravo Bruinsma, George J. ; van 't Hof, Arnoud W.J. ; Grandjean, Jan G. ; Peelen, Linda M. / Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery : A Large Cohort Study. In: International journal of vascular medicine. 2017 ; Vol. 2017.
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    title = "Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study",
    abstract = "The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2{\%}). Patients in the intervention group were on average older (71 versus 68 years, p<0.001) and more often females (31.0{\%} versus 28.0{\%}, p<0.001) and had a higher predicted mortality (EuroSCORE I: 5.9{\%} versus 4.0{\%}, p<0.001). The observed 30-day mortality was 2.2{\%} and 2.5{\%} in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95{\%} CI: 0.50-1.00, p=0.05) and 0.67 (95{\%} CI: 0.45-0.98, p=0.04). In-hospital stroke was 2.9{\%} and 2.1{\%} in both groups, respectively, with adjusted RRs of 1.03 (95{\%} CI: 0.73-1.45) and 1.01 (95{\%} CI: 0.71-1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.",
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    Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery : A Large Cohort Study. / Jansen Klomp, Wouter W.; Moons, Carl G.M.; Nierich, Arno P.; Brandon Bravo Bruinsma, George J.; van 't Hof, Arnoud W.J.; Grandjean, Jan G.; Peelen, Linda M.

    In: International journal of vascular medicine, Vol. 2017, 1857069, 2017.

    Research output: Contribution to journalArticleAcademicpeer-review

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    T1 - Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery

    T2 - A Large Cohort Study

    AU - Jansen Klomp, Wouter W.

    AU - Moons, Carl G.M.

    AU - Nierich, Arno P.

    AU - Brandon Bravo Bruinsma, George J.

    AU - van 't Hof, Arnoud W.J.

    AU - Grandjean, Jan G.

    AU - Peelen, Linda M.

    PY - 2017

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    N2 - The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p<0.001) and more often females (31.0% versus 28.0%, p<0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p<0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50-1.00, p=0.05) and 0.67 (95% CI: 0.45-0.98, p=0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73-1.45) and 1.01 (95% CI: 0.71-1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.

    AB - The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p<0.001) and more often females (31.0% versus 28.0%, p<0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p<0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50-1.00, p=0.05) and 0.67 (95% CI: 0.45-0.98, p=0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73-1.45) and 1.01 (95% CI: 0.71-1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.

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