Clinical Utility of Intraoperative Transesophageal Echocardiography for Crucial Monitoring and Hemodynamic Support in Patients with Low Cardiac Output- Tertiary Center Experience.

Fadel, Ahmed M.; Kamel, Reda K.; Abdul Azeem, Ehab S.; Ismail, Samir E.

doi:10.21608/bmfj.2025.384932.2411

Clinical Utility of Intraoperative Transesophageal Echocardiography for Crucial Monitoring and Hemodynamic Support in Patients with Low Cardiac Output- Tertiary Center Experience.

Document Type : Original Article

Authors

¹ Anesthesiology Department, Faculty of Medicine, Benha University, Benha, Egypt.

² Professor of anesthesia and intensive care Faculty of Medicine, Benha University

³ Professor of anesthesia and intensive care Faculty of Medicine - Benha University

⁴ Assistant professor of anesthesia and intensive care Faculty of Medicine - Benha University

10.21608/bmfj.2025.384932.2411

Abstract

Background: Intraoperative Transoesophageal Echocardiography (TEE) is a valuable tool for guiding surgical decisions and managing hemodynamic instability in cardiac surgery. However, its role in improving clinical outcomes remains underexplored. Objectives: To evaluate the utility of TEE in monitoring cardiac function and guiding pharmacological and mechanical support in patients with low Left Ventricular Ejection Fraction (LVEF) undergoing cardiac surgery. Methods: This prospective observational study included 98 patients with LVEF <35% undergoing cardiac surgery at Benha University Hospitals (December 2022–December 2023). TEE was performed pre- and post-bypass to assess hemodynamic parameters, including Cardiac Output (COP), Systemic Vascular Resistance (SVR), and End-Diastolic Area (EDA). Primary outcomes included changes in COP and LVEF, while secondary outcomes involved pharmacological and mechanical support requirements. Results: Postoperative COP significantly increased (3.2 ± 0.7 to 5.3 ± 1.2 L/min, p < 0.001), while SVR significantly decreased (1563.8 ± 396.1 to 1032.5 ± 280.5 dyn.sec/cm⁵, p < 0.001). LVEF improved postoperatively (29.7 ± 5.7% to 41.2 ± 8.4%, p < 0.001). Vasopressors were required in 49.9% of patients, inotropes in 76.5%, and mechanical support in 13.2%. TEE identified new intraoperative pathologies in 9.2%, leading to surgical modifications. Conclusions: TEE provides real-time assessment of cardiac function, enabling precise intraoperative interventions that optimize hemodynamic stability and improve surgical outcomes in high-risk cardiac patients.

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