Preoperative Transthoracic Echocardiography Findings in Patients Undergoing Non-Cardiac Surgery in a Tertiary Care Hospital: a Retrospective Study

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Sasithorn Thanasriphakdeekul
Aksorn Pulnitiporn
Bawornrut Sutanthavibul
Phantip Ninsawang

Abstract

Introduction: Patients with cardiovascular diseases are prone to developing cardiac complications during surgery. The patient’s history and physical examination alone do not provide enough information for an anesthetic plan. Preoperative transthoracic echocardiography (TTE) provides more specific and useful information. The objective of the study is aimed to determine the positive findings of preoperative TEE in patients undergoing non-cardiac surgery. Methods: A retrospective descriptive study was conducted from October 1, 2020 to September 30, 2021 with patients aged 18 years or older who received TTE examination before non- cardiac surgery. Based on the demographic data, major perioperative cardiovascular complications were collected from the preanesthetic evaluation forms, anesthesia consultation forms, as well as anesthesia and medical records. Results: 419 of 17,968 patients (2.3%) undergoing non-cardiac surgery received TTE examinations just before anesthesia, of which 191 (45.6%) were emergency cases. Most indications for TTE, operated by anesthesiologists (63.3%) and cardiologists (36.7%), were cardiac murmur (37.9%), high cardiac risk patients or high-risk surgery (20.0%), and coronary artery disease or suspected (15.8%). Abnormal TTE results, found in 348 patients (83.1%), included abnormal valve (58.3%), low ejection fraction (11.8%), left ventricular hypertrophy (9.2%), pulmonary hypertension (0.6%) and others (20.1%). Further, 12 patients experienced major perioperative cardiac complications. Conclusion: Preoperative TTE can detect abnormal findings up to 83.1%, mostly in cardiac valve lesions. Therefore, prospective randomized control studies should be further studied to evaluate the clinical efficacy of preoperative TTE performed by anesthesiologists.

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References

Charuluxananan S, Sriraj W, Punjasawadwong Y, et al. Perioperative and anesthetic adverse events in Thailand (PAAd Thai) incident reporting study: anesthetic profiles and outcomes. Asian Biomed. 2017;1:21-32.

Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Eng J Med. 2015;373:2258-69.

Canty DJ, Royse CF, Kilpatrick D, Bowman L, Royse AG. The impact of focused transthoracic echocardiography in the pre-operative clinic. Anaesthesia. 2012;67:618-25.

Dyck MV. Is echocardiography helpful in the pre-anaesthesia assessment? Acta Anaesthesiol Belgica. 2008;59:187-94.

Subramaniam K, Boisen ML, Yehushua L, Esper SA, Philips DP, Howard-Quijano K. Perioperative transthoracic echocardiography practice by cardiac anesthesiologists-report of a “start up” experience. J Cardiothorac Vasc Anesth. 2021;35:222-32.

Brakke TR, Desjardins G, Shillcutt SK, Vezina DP, Montzingo CR. Transthoracic echocardiography: training options for practicing physicians. J Cardiothorac Vasc Anesth. 2011;25:e42-3.

Canty DJ, Royse CF. Audit of anaesthetist-performed echocardiography on perioperative management decisions for non-cardiac surgery. Br J Anaesth. 2009;103:352-8.

Subramani S, Tewari A. Preoperative echocardiography: evidence or experience based utilization in non-cardiac surgery? J Anaesthesiol Clin Pharmacol. 2014;30:313-5.

Canty DJ, Royse CF, Kilpatrick D, Bowyer A, Royse AG. The impact on cardiac diagnosis and mortality of focused transthoracic echocar-diography in hip fracture surgery patients with increased risk of cardiac disease: a retrospective cohort study: pre-operative echocardiography

in hip fracture surgery. Anaesthesia. 2012;67:1202-9.

Kalem M, Kocaoglu H, Şahin E, Kocaoğlu MH, Başarır K, Kınık H. Impact of echocardiography on one-month and one-year mortality of intertrochanteric fracture patients. Acta Orthop Traumatol Turc. 2018;52:97-100.

Canty DJ, Royse CF, Kilpatrick D, Williams DL, Royse AG. The impact of pre-operative focused transthoracic echocardiography in emergency non-cardiac surgery patients with known or risk of cardiac disease. Anaesthesia. 2012;67:714-20.

Cowie B. Three years’ experience of focused cardiovascular ultrasound in the peri-operative period. Anaesthesia. 2011;66:268-73.

Barber RL, Fletcher SN. A review of echocardiography in anaesthetic perioperative practice. Part 1: impact and utility. Anaesthesia. 2014;69:764-76.

Smilowitz NR, Berger JS. Perioperative cardiovascular risk assessment and management for noncardiac surgery: a review. JAMA. 2020;324:279-90.

Sheu R, Geube M, Cormican D. Transthoracic echocardiography and the field of cardiothoracic anesthesiology: where do we stand? J Cardiothorac Vasc Anesthe. 2019;33:1489-91.

Lau G, Swanevelder J. Echocardiography in intensive care-where we are heading? Anaesthesia. 2011;66:649-58.

Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43:3826-924.