7 Monitoring by transoesophageal echocardiography in minimally invasive cardiac surgery

Abstract

Minimally invasive heart surgery, for either coronary artery or valve surgery, has been evaluated for a few years. Surgeons and anaesthesiologists have encountered new challenges with these new techniques. There is no doubt that ‘minimally invasive’ surgery increases the technical difficulty for the surgeon and limits the exposure of the heart. Transoesophageal echocardiography (TOE), by giving complete and on-line anatomical and haemodynamic information, will obviously take a major place in this setting. It gives an instantaneous view of the filling of cavities and the contractility of both ventricles, in a situation where the heart is not exposed. It allows a more complete de-airing to be performed at the end of surgery. Mitral valve repair can be evaluated at the end of surgery, which is mandatory in a situation where surgical difficulties are increased. Other indications of TOE are also presented; some development might arise in the future since minimally invasive surgery is still evolving.