Transoesophageal echocardiography (TEE)
A complete cardiac screening involving Transoesophageal Echocardiography (TEE) is recommended for all patients presenting for cardiothoracic at start of the surgery, to assess the atherosclerotic burden of the patients aorta. This guides the cardiac team in making appropriate decisions specific to that patient.
Atherosclerosis of the ascending aorta and aortic arch is recognized as one of the important predictors of postoperative stroke after cardiac interventions. Postoperative stroke is a multifactorial process, but the mobilization of emboli during manipulation of the aorta is believed to play an essential role. Release of emboli has been associated with post-operative delirium, cognitive dysfunction, renal dysfunction and mortality. Accurate detection of aortic atherosclerosis can lead to effective changes to the surgical management to ensure the best patient outcomes.
Timing of detection of atherosclerosis
A-View TEE has the advantage to be performed before the start of the intervention. Assessment of presence and severity of atherosclerosis at this time, allows the cardiac team sufficient planning time to decide on the safest approach before the intended procedure.
Modifying surgical strategy
Presence of severe atherosclerosis of the thoracic aorta will raise several questions regarding the optimal perioperative management. Modifications of the surgical management and anaesthesia can be considered:
Modification of anaesthesia