Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Jan;33(1):118-133.
doi: 10.1053/j.jvca.2018.07.040. Epub 2018 Aug 1.

Practice Pattern Variation in the Use of Transesophageal Echocardiography for Open Valve Cardiac Surgery

Emily J MacKay  1 , Peter W Groeneveld  2 , Lee A Fleisher  3 , Nimesh D Desai  4 , Jacob T Gutsche  5 , John G Augoustides  5 , Prakash A Patel  6 , Mark D Neuman  7
Affiliations
Multicenter Study

Practice Pattern Variation in the Use of Transesophageal Echocardiography for Open Valve Cardiac Surgery

Emily J MacKay et al. J Cardiothorac Vasc Anesth. 2019 Jan.

Abstract

Objective: The authors sought to assess for the presence of practice variation in the use of intraoperative transesophageal echocardiography (TEE) for open cardiac valve surgery.

Design: This study was a retrospective cohort analysis.

Setting: The administrative claims data used for this investigation were multi-institutional and a representative sample of commercially insured patients in the United States between 2010 and 2015.

Participants: The cohort consisted of adult patients, aged 18 years or older, undergoing open mitral valve (MV) or aortic valve (AV) surgery.

Interventions: This was an observational analysis without interventions.

Measurements and main results: Of 19,386 valve surgeries, 12,313 (64%) underwent AV replacement, 6,192 (32%) underwent MV repair or replacement, and 881 (<5%) underwent both MV and AV surgery. The overall rate of intraoperative TEE was 82% (95% confidence interval [CI]: 81%-82%), less frequently observed in AV procedures compared to MV or combined MV-AV procedures (80% v 85%, p < 0.001). Rates of intraoperative TEE claims varied markedly across U.S. states. After adjustment, the relative odds of an intraoperative TEE claim ranged across states from 0.26 (Louisiana, 95% CI: 0.18-0.36; p < 0.001) to 2.10 (North Carolina, 95% CI: 1.57-2.82; p < 0.001).

Conclusion: Among adult patients undergoing open AV or MV surgery in the United States, 82% had a claim for an intraoperative TEE with marked variability across U.S. states. Increasing adherence to intraoperative TEE guidelines for valve surgery may represent an unrecognized opportunity to improve the quality of cardiac surgical care.

Keywords: aortic valve surgery; cardiovascular surgery; ethics and policy; guideline compliance and adherence; health services; intraoperative echocardiography; mitral valve surgery; transesophageal echocardiography.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest:

All co-authors declare no competing interests

Figures

Figure 1:
Figure 1:
Geographic variation in TEE guideline adherence among 19,386 undergoing aortic valve or mitral valve surgery from 2010 – 2015. The overall rate of TEE utilization observed in the data set was 82% (95% CI 81 – 82%). Among states with a minimum of 100 eligible cases, TEE utilization varied from 61% in both AL (95% CI: 56 – 66%) and LA (95% CI: 53 – 68%) to 92% (NC, 95% CI: 90 – 94%).
Figure 2:
Figure 2:
Geographic variation in TEE guideline adherence among 12,313 undergoing aortic valve replacement surgery from 2010–2015. The overall rate of TEE utilization observed in the aortic valve subgroup was 80% (95% CI 79 – 81%). Among states with a minimum of 100 cases, TEE utilization varied from 49% (AL; 95% CI 41 – 56%) to 92% (NC; 95% CI: 89 – 94%).
Figure 3:
Figure 3:
Geographic variation in TEE guideline adherence among 7,073 undergoing mitral valve repair or replacement surgery from 2010 – 2015. The overall rate of TEE utilization observed in the mitral valve subgroup was 85% (95% CI 84 – 86%). Among states with a minimum of 100 cases, TEE utilization varied from 73% (TN; 95% CI: 65 – 80%) to 94% (UT; 95% CI: 88 – 97%).
See this image and copyright information in PMC

Comment in

References

    1. Nkomo VT, Gardin JM, Skelton TN, et al. : Burden of valvular heart diseases: a population-based study. Lancet. 368:1005–1011, 2006. - PubMed
    1. Surgeons ESSoT: Executive Summary Adult Cardiac Surgery Database. vol 2016. Society of Thoracic Surgeons; 2015.
    1. American Society of A, Society of Cardiovascular Anesthesiologists Task Force on Transesophageal E: Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology. 112:1084–1096, 2010. - PubMed
    1. American College of Cardiology Foundation Appropriate Use Criteria Task F, American Society of E, American Heart A, et al. : ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol. 57:1126–1166, 2011. - PubMed
    1. Nishimura RA, Otto CM, Bonow RO, et al. : 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 148:e1–e132, 2014. - PubMed

Publication types