Impact Of Transesophageal Echocardiography-guided Hemodynamic Optimization On Fast-track Recovery After Cardiac Surgery

Summary

This retrospective study evaluates the impact of intraoperative transesophageal echocardiography-guided hemodynamic optimization on fast-track recovery in cardiac surgery. By implementing a closed-loop protocol focused on volume phenotyping and cardiac function, the intervention was associated with shorter extubation time and reduced ICU length of stay compared with standard care.

Abstract

Perioperative volume misclassification and cardiac dysfunction often hinder fast-track recovery following cardiac surgery. This retrospective cohort study evaluated whether intraoperative transesophageal echocardiography (TEE)-guided hemodynamic optimization was associated with improved fast-track outcomes. Seventy-two adult patients undergoing cardiac surgery received either TEE-guided optimization (n = 34) or standard care (n = 38). The intervention involved goal-directed hemodynamic management based on TEE phenotyping of volume status and cardiac function at predefined intraoperative time points, including post-induction, prior to cardiopulmonary bypass, during weaning from bypass, and before chest closure. Clinical decisions were guided by predefined objective criteria, including left ventricular end-diastolic area and stroke volume responsiveness for fluid management, and ejection fraction and regional wall motion abnormalities for inotropic support. Inverse probability of treatment weighting was used to adjust for baseline imbalances. TEE-guided optimization was associated with shorter time to extubation and reduced intensive care unit length of stay compared with standard care. The intervention group also showed improved early postoperative perfusion profiles without an observed increase in major complications. These findings suggest that intraoperative TEE-guided hemodynamic optimization may support fast-track recovery after cardiac surgery, although larger prospective studies are needed to confirm these results.

Introduction

Cardiac surgery, particularly valve replacement or major vascular procedures involving extracorporeal circulation, induces complex pathophysiological changes¹. Surgical trauma, systemic inflammatory responses induced by extracorporeal circulation, and myocardial ischemia-reperfusion injury are primary drivers of intraoperative hemodynamic fluctuations. Driven by the principles of accelerated recovery after surgery (ERAS), the Fast Track Cardiac Surgery Protocol (FTCP) has become a critical pathway to improving patient outcomes^2,3. This protocol aims to minimize multi-organ stress throug....

Protocol

The research protocol was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of China Medical University (AF-SOP-07-1.2-01). All investigative procedures were conducted in strict adherence to the ethical standards of the institutional research committee and the 1964 Helsinki Declaration. Given the retrospective study design and the use of anonymized patient data, the committee formally waived the requirement for informed consent.

Study design

This study employed a retrospective cohort design, utilizing a single-center cardiac surgery perioperative database and ....

Results

Baseline characteristics

This study enrolled 72 cardiac surgery patients: 34 in the TEE-guided closed-loop optimization group and 38 in the conventional management group. The two groups were generally comparable in most demographic characteristics and underlying comorbidities, with no statistically significant differences in gender distribution, body mass index (BMI), smoking status, or the proportions of hypertension, diabetes, chronic obstructive pulmonary disease (COPD), an.......

Discussion

This retrospective two-group controlled study focused on the real-time assessment and intervention optimization of volume status and cardiac function via intraoperative transesophageal echocardiography (TEE)¹⁴. The results demonstrated an overall improvement in rapid pathway outcomes, with key manifestations including shorter mechanical ventilation duration and smoother perioperative transition¹⁵. These findings align with recent evidence supporting the rapid recovery conce.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Anesthesia Workstation	Dräger	Perseus A500	Used for general anesthesia delivery and ventilation
Hemodynamic Monitoring System	Edwards Lifesciences	EV1000	Continuous arterial pressure and hemodynamic monitoring
R software	R Foundation for Statistical Computing	Version 4.2.1	Open-source software utilized for propensity score estimation and weighted analysis
SPSS Statistics	IBM	Version 26.0	Utilized for demographic data processing and primary statistical analysis
TEE Adult Multiplane Probe	GE Healthcare / Philips Healthcare	Adult multiplane probe	Standard adult probe for perioperative transesophageal imaging
Transesophageal Echocardiography System	GE Healthcare / Philips Healthcare	EPIQ CVx / Vivid E95	Used for intraoperative cardiac imaging and hemodynamic assessment