Assessment of regional wall motion abnormality using transesophageal echocardiography in patient undergoing off pump coronary artery bypass grafting – An observational study

Abstract

Context: Transesophageal echocardiography (TOE) has been widely used intraoperatively in cardiovascular surgeries. Its influence on perioperative decision-making in both surgical and pharmacological planning has been well recognized. A study was undertaken to establish the fact that the routine use of TOE not only reduces the complications of Coronary artery bypass grafting procedures, but also helps in better surgical decision-making. Aims: To compare the regional wall motion abnormality (RWMA) using TOE at pre and postgrafting Off-pump coronary artery bypass (OPCAB) procedure. Settings and Design: The study design involves institutional setting and observational study. Subjects and Methods: Seventy-two adult patients undergoing elective OPCAB procedures were included between January 2019 and June 2020. RWMA and ejection fraction (EF) were assessed before grafting and postgrafting using intraoperative TOE (IOTOE) to quantify the improvement of wall motion, if no improvement then the need for graft revision or additional grafting was suggested. Statistical Analysis Used: Quantitative outcomes were compared using paired t-tests. SPSS 20.0 was used to analyze the data collected. P < 0.05 was considered to be statistically significant. Results: Sixty-five (90%) patients had RWMA and EF improvement after the grafting and 3 (4%) patients had improvement after graft revision as suggested by IOTOE. So, 68 (94%) patients out of 72 had good surgical outcomes. The comparison between pre and postgrafting EF showed a statistically significant difference i.e., P < 0.05. Conclusions: IOTOE can be used routinely as a definitive mandatory monitoring tool to help in appropriate intra-operative surgical decision-making in patients undergoing OPCAB to enable better surgical outcomes and thereby reduce the morbidity and mortality associated with the procedure.