Perioperative Transthoracic and Transesophageal Echocardiography on Non-Cardiac Surgery
DOI:
https://doi.org/10.25751/rspa.17470Keywords:
Echocardiography; Echocardiography, Transesophageal; Heart Diseases/complications; Perioperative Period; Risk AssessmentAbstract
Cardiovascular complications are one of the main causes of perioperative mortality and morbidity. Preoperative cardiac evaluation is, therefore, paramount. The purpose of this article is to determine which patients scheduled for non-cardiac surgery should have a preoperative transthoracic echocardiographic evaluation as well as those who benefit from monitoring with transesophageal echocardiography, taking into consideration their cardiac disease and the type of surgery they will undergo.
We searched PubMed for articles of interest dated from January 1990 until September 2018. We selected mostly national and international guidelines, systematic reviews and randomized trials.
In addition to medical history, physical examination, risk scores, laboratory evaluation and electrocardiography, echocardiography, both at rest and after stress, can be useful in the stratification of
cardiac risk in selected situations, taking into account the impact on optimization of the patient.
Various guidelines have been published regarding the use of echocardiography in patients scheduled for non-cardiac surgery and they mostly recommend it in patients undergoing high cardiac risk surgery or patients with severe cardiac disease (heart failure, ischemic heart disease, heart valve disease) undergoing high or intermediate cardiac risk surgery. Transesophageal echocardiography during the intraoperative period on non-cardiac surgery is not recommended routinely, being mostly used during major vascular surgery and in patients with serious and persistent hemodynamic instability.
Downloads
Download data is not yet available.
References
1. De Hert S, Staender S, Fritsch G, Hinkelbein J, Afshari A, Bettelli G, et al. Preoperative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anesthesiology. Eur J
Anaesthesiol. 2018; 35:407-65. doi: 10.1097/EJA.0000000000000817.
2. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130:278-333. doi: 10.1161/ CIR.0000000000000106.
3. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100:1043-9.
4. Wijeysundera DN, Duncan D, Nkonde-Price C, Virani SS, Washam JB, Fleischmann KE, et al. Perioperative betablockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Herat Association Task Force on Practice Guidelines.
Circulation. 2014; 130:2246-64. doi: 10.1161/CIR.0000000000000104.
5. Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Inter Med. 2001; 134:637-43
6. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014; 35:2383-431. doi: 10.1093/eurheartj/ehu282.
7. Wijeysundera DN, Beattie WS, Karkouti K, Neuman MD, Austin PC, Laupacis A. Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study. BMJ. 2011; 342:d3695
8. Foy AJ, Ting JG. The harms of an unnecessary preoperative echocardiogram: A teachable moment. JAMA Intern Med. 2014; 174:853-4. doi: 10.1001/ jamainternmed.2014.379.
9. Shim CY. Preoperative cardiac evaluation with transthoracic echocardiography before non-cardiac surgery. Korean J Anesthesiol. 2017; 70:390-7. doi: 10.4097/ kjae.2017.70.4.390.
10. Park SJ, Choi JH, Cho SJ, Chang SA, Choi JO, Lee SC, et al. Comparison of transthoracic echocardiography with N-terminal pro-brain natriuretic peptide as a tool for risk stratification of patients undergoing major noncardiac surgery. Korean Circ J. 2011; 41:505-11. oi: 10.4070/kcj.2011.41.9.505
11. British Society of Echocardiography. Clinical Indications for Echocardiography. [accessed 5 October 2018] Available at: https://www.bsecho.org/indicationsfor- echocardiography/.
12. National Institute for Health and Care Excellence (NICE). Routine preoperative tests for elective surgery. 2016 (NICE Guideline 45). [accessed 4 October 2018] Available at: https://www.nice.org.uk/guidance/ng45.
13. Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT. Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Ann Intern Med. 1996; 125:433-41.
14. Rohde LE, Polanczyk CG, Goldman L, Cook EF, Lee RT, Lee TH. Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. Am J Cardiol. 2001; 97:508-9.
15. Kertai MD, Boersma E, Bax JJ, Heijenbrok-Kal MH, Hunink MG, L'talien GJ, et al. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart. 2003; 89:1327-1334
16. Khouri SJ, Maly GT, Suh DD, Wlash TE. A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr. 2004: 17:290-7.
17. Marques AC, Caramelli B. O ecocardiograma na avaliação do risco perioperatório. Rev Bras Ecocardiogr. 2008; 21:45-9.
18. Woodward MN, Earnshaw JJ, Heather BP. The value of QTc dispersion in assessment of cardiac risk in elective aortic aneurysm surgery. Eur J Vasc Endovasc Surg. 1998; 15:267-9.
19. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/ AHA/ASNC Guidelines for the clinical use of cardiac radionuclide imaging: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2003; 42:1318-33.
20. Tan TC, Dudzinski DV, Hung J, Mehta V. Peri-operative assessment of right heart function: role of echocardiography. Eur J Clin Invest. 2015; 45:755-66. doi: 10.1111/eci.12462.
21. Kaw R, Pasupuleti V, Deshpande A, Hamieh T, Walker E, Minair OA. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery. Respir Med. 2011; 105:619-24.
22. Morris CK, Ueshima K, Kawaguchi T. The prognostic value of exercise capacity: A review of the literature. Am Heart J. 1991; 122:1423-31.
23. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, et al. Stress echocardiography expert consensus statement: European Association of Echocardiography. Eur J Echocardiogr. 2008; 9:415-37. doi: 10.1093/ejechocard/jen175.
24. Bach DS, Curtis JL, Christensen PJ, Iannettoni MD, Whyte RI, Kazerooni EA, et al. Preoperative echocardiographic evaluation of patients referred for lung volume reduction surgery. Chest. 1998; 114: 972-80.
25. Bossone E, Martinez FJ, Whyte RI, Iannettoni MD, Armstrong WF, Bach DS. Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery. J Thorac Cardiovasc Surg. 1999; 118:542-6.
26. Gualandro DM, Yu Pc, Caramelli B, Marques AC, Calderaro D, Fornari LS, et al. 3rd Guideline for perioperative cardiovascular evaluation of the Brazilian Society of Cardiology. Arq Bras Cardiol. 2017; 109:1-104. doi: 10.5935/abc.20170140.
27. 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. 2010; 112:1084-96. doi: 10.1097/ ALN.0b013e3181c51e90.
28. Reeves ST, Finley AC, Skubas NJ , Swaminathan M, Whitley WS, Glas KE, et al. Basic perioperative transesophageal echocardiography examination: A consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg. 2013; 117:543-58.
doi: 10.1016/j.echo.2013.02.015.
29. Fayad A, Shillcutt SK. Perioperative transesophageal echocardiography for non-cardiac surgery. Can J Anesth. 2017; 65:381-98.
30. Nicoara A, Whitener G, Swaminathan M. Perioperative diastolic dysfunction: A comprehensive approach to assessment by transesophageal echocardiography. Semin Cardiothorac Vasc Anesth. 2013; 18:218-36.
31. McIlroy DR, Lin E, Durkin C. Intraoperative transesophageal echocardiography: A critical appraisal of its current role in assessment of diastolic dysfunction. J Cardiothorac Vasc Anesth. 2015; 29:1033-43. doi: 10.1053/j.jvca.2015.01.009
32. Salgado-Filho MF, Morhy SS, de Vasconcelos HD, Lineburger EB, Papa FV, Botelho ES, et al. Consenso sobre ecocardiografia transesofágica perioperatória da Sociedade Brasileira de Anestesiologia e do Departamento
de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia. Rev Bras Anestesiol. 2018; 68:1-32.
33. Hauser ND, Swanevelder J. Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE. Echo Res Pract. 2018; 5:R101-R113. doi: 10.1530/ERP-18-0047.
34. Rebel A, Klimkina O, Hassan ZU. Tranesophageal echocardiography for the noncardiac surgical patient. Int Surg. 2012; 97:43-55.
35. London MJ, Tubau JF, Wong MG, Layug E, Hollenberg M, Krupski WC, et al. The “natural history” of segmental wall motion abnormalities in patients undergoing noncardiac surgery. Anesthesiology. 1990; 73:644-55.
36. Schulmeyer C, Farías J, Rajdl E, de La Maza J, Labbé M. Utility of transesophageal echocardiography during severe hypotension in non-cardiac surgery. Rev Bras Anestesiol. 2010; 60:513-21.
37. Evans A, Dwarakanath S, Hogue C, Brady M, Poppers J, Miller S, et al. Intraoperative echocardiography for patients undergoing lung transplantation. Anesth Analg. 2014; 118:725-30. doi: 10.1213/ANE.0000000000000121.
38. Flachskampf FA, Wouters PF, Edvardsen T, Evangelista A, Habib G, Hoffman P, et al. Recommendations for transesophageal echocardiography: EACVI update 2014. Eur Heart J. 2014; 15:353-65. doi: 10.1093/ehjci/jeu015.
39. Mahmood F, Christie A, Matyal R. Transesophageal echocardiography and noncardiac surgery. Semin Cardiothorac Vasc Anesth. 2008; 12:265-89.
40. American Society of Anesthesiologists. Statement on transesophageal echocardiography 2015. [accessed 5 October 2018] Available at: http://www.asahq.org/quality-and-practice-management/standards-guidelines-andrelated-resources/statement-on-transesophageal-echocardiography.
41. Haskins SC, Vaz AM, Garvin S. Perioperative point-of-care ultrasound for the anesthesiologist. J Anesth Perioper Med. 2018; 5:92-6.
42. Ramsingh D, Fox JC, Wilson WC. Perioperative point-of-care ultrasonography: An emerging technology to be embraced by anesthesiologists. Anesth Analg. 2015; 120:990-2. doi: 10.1213/ANE.0000000000000702.
43. Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013; 26:567-81. doi: 10.1016/j.echo.2013.04.001
Anaesthesiol. 2018; 35:407-65. doi: 10.1097/EJA.0000000000000817.
2. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130:278-333. doi: 10.1161/ CIR.0000000000000106.
3. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100:1043-9.
4. Wijeysundera DN, Duncan D, Nkonde-Price C, Virani SS, Washam JB, Fleischmann KE, et al. Perioperative betablockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Herat Association Task Force on Practice Guidelines.
Circulation. 2014; 130:2246-64. doi: 10.1161/CIR.0000000000000104.
5. Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Inter Med. 2001; 134:637-43
6. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014; 35:2383-431. doi: 10.1093/eurheartj/ehu282.
7. Wijeysundera DN, Beattie WS, Karkouti K, Neuman MD, Austin PC, Laupacis A. Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study. BMJ. 2011; 342:d3695
8. Foy AJ, Ting JG. The harms of an unnecessary preoperative echocardiogram: A teachable moment. JAMA Intern Med. 2014; 174:853-4. doi: 10.1001/ jamainternmed.2014.379.
9. Shim CY. Preoperative cardiac evaluation with transthoracic echocardiography before non-cardiac surgery. Korean J Anesthesiol. 2017; 70:390-7. doi: 10.4097/ kjae.2017.70.4.390.
10. Park SJ, Choi JH, Cho SJ, Chang SA, Choi JO, Lee SC, et al. Comparison of transthoracic echocardiography with N-terminal pro-brain natriuretic peptide as a tool for risk stratification of patients undergoing major noncardiac surgery. Korean Circ J. 2011; 41:505-11. oi: 10.4070/kcj.2011.41.9.505
11. British Society of Echocardiography. Clinical Indications for Echocardiography. [accessed 5 October 2018] Available at: https://www.bsecho.org/indicationsfor- echocardiography/.
12. National Institute for Health and Care Excellence (NICE). Routine preoperative tests for elective surgery. 2016 (NICE Guideline 45). [accessed 4 October 2018] Available at: https://www.nice.org.uk/guidance/ng45.
13. Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT. Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Ann Intern Med. 1996; 125:433-41.
14. Rohde LE, Polanczyk CG, Goldman L, Cook EF, Lee RT, Lee TH. Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. Am J Cardiol. 2001; 97:508-9.
15. Kertai MD, Boersma E, Bax JJ, Heijenbrok-Kal MH, Hunink MG, L'talien GJ, et al. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart. 2003; 89:1327-1334
16. Khouri SJ, Maly GT, Suh DD, Wlash TE. A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr. 2004: 17:290-7.
17. Marques AC, Caramelli B. O ecocardiograma na avaliação do risco perioperatório. Rev Bras Ecocardiogr. 2008; 21:45-9.
18. Woodward MN, Earnshaw JJ, Heather BP. The value of QTc dispersion in assessment of cardiac risk in elective aortic aneurysm surgery. Eur J Vasc Endovasc Surg. 1998; 15:267-9.
19. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/ AHA/ASNC Guidelines for the clinical use of cardiac radionuclide imaging: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2003; 42:1318-33.
20. Tan TC, Dudzinski DV, Hung J, Mehta V. Peri-operative assessment of right heart function: role of echocardiography. Eur J Clin Invest. 2015; 45:755-66. doi: 10.1111/eci.12462.
21. Kaw R, Pasupuleti V, Deshpande A, Hamieh T, Walker E, Minair OA. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery. Respir Med. 2011; 105:619-24.
22. Morris CK, Ueshima K, Kawaguchi T. The prognostic value of exercise capacity: A review of the literature. Am Heart J. 1991; 122:1423-31.
23. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, et al. Stress echocardiography expert consensus statement: European Association of Echocardiography. Eur J Echocardiogr. 2008; 9:415-37. doi: 10.1093/ejechocard/jen175.
24. Bach DS, Curtis JL, Christensen PJ, Iannettoni MD, Whyte RI, Kazerooni EA, et al. Preoperative echocardiographic evaluation of patients referred for lung volume reduction surgery. Chest. 1998; 114: 972-80.
25. Bossone E, Martinez FJ, Whyte RI, Iannettoni MD, Armstrong WF, Bach DS. Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery. J Thorac Cardiovasc Surg. 1999; 118:542-6.
26. Gualandro DM, Yu Pc, Caramelli B, Marques AC, Calderaro D, Fornari LS, et al. 3rd Guideline for perioperative cardiovascular evaluation of the Brazilian Society of Cardiology. Arq Bras Cardiol. 2017; 109:1-104. doi: 10.5935/abc.20170140.
27. 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. 2010; 112:1084-96. doi: 10.1097/ ALN.0b013e3181c51e90.
28. Reeves ST, Finley AC, Skubas NJ , Swaminathan M, Whitley WS, Glas KE, et al. Basic perioperative transesophageal echocardiography examination: A consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg. 2013; 117:543-58.
doi: 10.1016/j.echo.2013.02.015.
29. Fayad A, Shillcutt SK. Perioperative transesophageal echocardiography for non-cardiac surgery. Can J Anesth. 2017; 65:381-98.
30. Nicoara A, Whitener G, Swaminathan M. Perioperative diastolic dysfunction: A comprehensive approach to assessment by transesophageal echocardiography. Semin Cardiothorac Vasc Anesth. 2013; 18:218-36.
31. McIlroy DR, Lin E, Durkin C. Intraoperative transesophageal echocardiography: A critical appraisal of its current role in assessment of diastolic dysfunction. J Cardiothorac Vasc Anesth. 2015; 29:1033-43. doi: 10.1053/j.jvca.2015.01.009
32. Salgado-Filho MF, Morhy SS, de Vasconcelos HD, Lineburger EB, Papa FV, Botelho ES, et al. Consenso sobre ecocardiografia transesofágica perioperatória da Sociedade Brasileira de Anestesiologia e do Departamento
de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia. Rev Bras Anestesiol. 2018; 68:1-32.
33. Hauser ND, Swanevelder J. Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE. Echo Res Pract. 2018; 5:R101-R113. doi: 10.1530/ERP-18-0047.
34. Rebel A, Klimkina O, Hassan ZU. Tranesophageal echocardiography for the noncardiac surgical patient. Int Surg. 2012; 97:43-55.
35. London MJ, Tubau JF, Wong MG, Layug E, Hollenberg M, Krupski WC, et al. The “natural history” of segmental wall motion abnormalities in patients undergoing noncardiac surgery. Anesthesiology. 1990; 73:644-55.
36. Schulmeyer C, Farías J, Rajdl E, de La Maza J, Labbé M. Utility of transesophageal echocardiography during severe hypotension in non-cardiac surgery. Rev Bras Anestesiol. 2010; 60:513-21.
37. Evans A, Dwarakanath S, Hogue C, Brady M, Poppers J, Miller S, et al. Intraoperative echocardiography for patients undergoing lung transplantation. Anesth Analg. 2014; 118:725-30. doi: 10.1213/ANE.0000000000000121.
38. Flachskampf FA, Wouters PF, Edvardsen T, Evangelista A, Habib G, Hoffman P, et al. Recommendations for transesophageal echocardiography: EACVI update 2014. Eur Heart J. 2014; 15:353-65. doi: 10.1093/ehjci/jeu015.
39. Mahmood F, Christie A, Matyal R. Transesophageal echocardiography and noncardiac surgery. Semin Cardiothorac Vasc Anesth. 2008; 12:265-89.
40. American Society of Anesthesiologists. Statement on transesophageal echocardiography 2015. [accessed 5 October 2018] Available at: http://www.asahq.org/quality-and-practice-management/standards-guidelines-andrelated-resources/statement-on-transesophageal-echocardiography.
41. Haskins SC, Vaz AM, Garvin S. Perioperative point-of-care ultrasound for the anesthesiologist. J Anesth Perioper Med. 2018; 5:92-6.
42. Ramsingh D, Fox JC, Wilson WC. Perioperative point-of-care ultrasonography: An emerging technology to be embraced by anesthesiologists. Anesth Analg. 2015; 120:990-2. doi: 10.1213/ANE.0000000000000702.
43. Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013; 26:567-81. doi: 10.1016/j.echo.2013.04.001
Downloads
Published
2019-06-13
How to Cite
Carrão, A., & Pereira, S. (2019). Perioperative Transthoracic and Transesophageal Echocardiography on Non-Cardiac Surgery. Journal of the Portuguese Society of Anesthesiology, 28(2), 110–118. https://doi.org/10.25751/rspa.17470
Issue
Section
Narrative Reviews
License
Articles are freely available to be read, downloaded and shared from the time of publication.
The RSPA reserves the right to commercialize the article as an integral part of the journal (in the preparation of reprints, for example). The author should accompany the submission letter with a declaration of copyright transfer for commercial purposes.
Articles are published under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC).
After publication in RSPA, authors are allowed to make their articles available in repositories of their home institutions, as long as they always mention where they were published.
