Impact of intraoperative transesophageal echocardiography on acute type-A aortic dissection.

Objective To evaluate the impact of intraoperative transesophageal echocardiography on type-A acute aortic dissection. Design Retrospective observational study. Setting Tertiary care hospital. Participants Sixty-four consecutive patients with type-A aortic dissection. Interventions Surgeons interviewed regarding how transesophageal echocardiography changed the surgical procedure. Measurements and Main Results Transesophageal echocardiography confirmed an ascending aorta intimal flap in 53 (83%) patients and an intramural hematoma in 9 (14%) patients. The aortic valve was bicuspid in 5 (8%) cases and a prior prosthetic valve was present in 4 (6%) patients. Aortic insufficiency was moderate in 12 (19%) cases and severe in 18 (28%) patients. Additionally, transesophageal echocardiography was useful in defining the size of pericardial effusion in 18 (28%) patients, 8 with large effusions and/or tamponade. Altogether, transesophageal echocardiography added data beyond prior imaging in 41 (64%) patients, including moderate or severe mitral regurgitation, right ventricular dysfunction, and atrial septal defects. The findings from intraoperative transesophageal echocardiography led directly to a change in planned surgery in 25 (39%) patients. Transesophageal echocardiography verified suitability of the repair in all cases of interposition graft or valve repair. Conclusions Intraoperative transesophageal echocardiography provides incremental information to the original imaging examination in the management of type-A acute aortic dissection in nearly two-thirds of patients, leading to a change in the planned surgery in 39% of patients, thus supporting its role as suggested in recent guidelines.