Journal of Thoracic and Cardiovascular Surgery
Journal of Thoracic and Cardiovascular Surgery
4 years ago

Is hemodynamic transesophageal echocardiography needed for patients with left ventricular assist device?

Interventions in patients with left ventricular assist device (LVAD) in the intensive care unit (ICU) are typically performed based on conventional monitoring, such as vital signs, Swan-Ganz catheter (SGC) and LVAD parameters. These variables may not always accurately reflect patient’s cardiac function, volume status, and inter-ventricular septal configuration. To assess the accuracy of standard monitoring, we performed routine continuous hemodynamic transesophageal echocardiography (hTEE) to evaluate cardiac function, volume status, and septal position. Methods Between 2011 and 2015, 93 HeartMate II LVADs were implanted. The study group consisted of 30 patients with SGC in place, who were monitored routinely in the ICU every 1-3 hour with hTEE until extubation. A total of 147 hTEE studies were performed and retrospectively analyzed to observe differences between conventional monitoring and hTEE. Results Among studied patients, 26 patients (87%) had at least one disagreement between conventional monitoring and hTEE findings. In 22 patients (73%), at least one of the hTEE studies showed that conventional parameters were normal while hTEE was abnormal. Abnormal hTEE findings were shift in the inter-ventricular septum in 19 patients (63%), abnormal ventricular volume status in 22 patients (73%), and right ventricular failure in 9 patients (30%). Based on conventional monitoring, none of the patients required LVAD speed change, while hTEE showed that 14 patients (47%) needed LVAD speed adjustment. Conclusions Conventional monitoring in the ICU may not provide an accurate representation of cardiac function, ventricular volume status, or septal position in patients with LVAD. Continuous monitoring with hTEE for the LVAD may guide toward optimal intervention in the ICU setting during early postoperative period.

Publisher URL: www.sciencedirect.com/science

DOI: S0022522317324303

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.