Transesophageal Echocardiography for Cardiac Surgery Patients With Prior Esophagectomies: Insights From a 15-Year Institutional Experience.

Transesophageal echocardiography (TEE) has become a routine diagnostic and monitoring technique during cardiac surgery. However, contraindications to TEE may warrant a preoperative multidisciplinary discussion of the relative risks and benefits of the procedure, among which is a history of esophagectomy. Consensus guidelines consider TEE indicated for cardiac surgeries involving heart valves or the thoracic aorta but consider a prior esophagectomy as a relative contraindication. 1 Hahn R.T. Abraham T. Adams M.S. et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013; 26: 921-964 Abstract Full Text Full Text PDF PubMed Scopus (754) Google Scholar The safety, prevalence, and imaging ability of TEE in cardiac surgery patients with a history of bariatric surgery have been described elsewhere, but no data exist for those with esophagectomy. 2 Kelava M. Koprivanac M. Alfirevic A. et al. Safety of transesophageal echocardiography for cardiac surgery in patients with histories of bariatric surgery. J Am Soc Echocardiogr. 2020; 33: 130-132 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Whereas the benefit of TEE in cardiac surgery is well documented, information regarding the imaging quality and gastric injury rate of TEE in esophagectomy patients is lacking. 3 MacKay E.J. Neuman M.D. Fleisher L.A. et al. Transesophageal echocardiography, mortality, and length of hospitalization after cardiac valve surgery. J Am Soc Echocardiogr. 2020; 33: 756-762.e1 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar A qualification of clinical benefit versus risks of TEE during cardiac surgery in patients with prior esophagectomy would aid in clinical decision-making, and as such we sought to qualify (1) the quality of TEE images obtained in these patients; (2) adverse events related to probe placement; and (3) cardiac anesthesiologist opinions and experiences related to such cases.