Review of intraoperative TOE

Introduction In 2000, Westmead Hospital Department of Anaesthesia made a survey of the use of intraoperative transoesophageal echocardiography (TOE) by cardiac surgical units throughout Australia. At that time, 80% of cardiac units were using intraoperative TOE, of which the anaesthetist was primarily responsible for the interpretation in 72%. Were we to conduct the same survey in 2009, I believe we would be hard pressed to find a unit where intraoperative TOE is not an essential component of practice for the cardiac anaesthetist. For valvular surgery, and for valve repairs in particular, intraoperative TOE has become a standard of care. While there is still some debate about the necessity and cost benefit analysis for its use for the routine coronary artery bypass graft (CABG) patient with good left ventricular function, it is also true that with advances in interventional cardiology, these less complicated patients are likely to be undergoing stenting procedures instead of surgery. The older, sicker, patient with multiple co-morbidities who may be undergoing combined valve coronary artery grafting surgery or re-do surgery now makes up an increasing proportion of our workload. The purpose of this review is to outline the current status and role of intraoperative TOE in the cardiac surgery unit as well as the particular Review of intraoperative TOE