Top Things to Know: Considerations of Intraoperative Transesophageal Echocardiography During Adult Cardiac Surgery
Published: June 12, 2025
Prepared by Lisa Q. Rong, MD, FACC, FASE
- Although intraoperative transesophageal echocardiography (TEE) is increasingly important in cardiac surgery for monitoring, decision-making, and improving clinical outcomes, current society guidelines have not been updated with the latest evidence on its benefits.
- Intraoperative TEE use has been shown to improve outcomes and reduce mortality in high-risk cardiac surgery patients, particularly those undergoing coronary artery bypass graft (CABG), valve, and aortic surgeries.
- Intraoperative TEE use is cost-effective while reducing long-term complications after cardiac surgery and lowering healthcare costs.
- When used in perioperative settings, TEE can effectively help risk stratify cardiac surgical patients, aid in stroke risk assessment, and inform hemodynamic and fluid management to closely monitor and improve outcomes.
- Real-time 3-dimentional (3D) TEE may be used intraoperatively to identify abnormalities and visualize complex lesions with better accuracy, sensitivity, and specificity than 2-dimensional (2D) TEE without compromising exam efficiency.
- Intraoperative TEE of the aorta during aortic surgery provides superior image quality compared to transthoracic echocardiography (TTE) and assists with arterial site cannulation guidance, identification of aortic aneurysm parameters, and endovascular techniques.
- TEE evaluation before left ventricular assist device (LVAD) implantation is important to evaluate key parameters and conditions that may alter the surgical procedure. Assessment of left and right ventricular function after orthotopic heart transplantation is also imperative.
- TEE may help determine the appropriate inotropic, pharmacological, and mechanical therapies for patients requiring veno-arterial extracorporeal membrane oxygenation (ECMO), as well as assisting with successful ECMO weaning.
- Intraoperative TEE is critical for evaluating the quality of surgical interventions in adult patients with congenital heart disease (CHD), as intraoperative echocardiography may alter the surgical plan and detect residual lesions that account for morbidity and mortality after CHD repair.
- The use of artificial intelligence (AI) techniques in intraoperative TEE may increase the speed and accuracy of diagnoses, enhance perioperative echocardiography workflow, and predict clinical outcomes.
Citation
Rong LQ, Shore-Lesserson L, Belani K, Faloye A, Garcia-Sayan E, Lawton J, Maus T, Miller-Hance W, Nicoara A, Sheu R; on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia; and Council on Basic Cardiovascular Sciences. Considerations of intraoperative transesophageal echocardiography during adult cardiac surgery: a scientific statement from the American Heart Association. Circulation. Published online June 12, 2025. doi: 10.1161/ CIR.0000000000001342