• David J Canty, Johan Heiberg, Jen A Tan, Yang Yang, Alistair G Royse, Colin F Royse, Abdulelah Mobeirek, Shaer Fayez El FE King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia., Turki Albacker, Rakan I Nazer, Muhammed Fouda, Bakir M Bakir, and Ahmed A Alsaddique.
• Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
• J. Cardiothorac. Vasc. Anesth. 2017 Jun 1; 31 (3): 965-972.

ObjectivesThe use of limited transthoracic echocardiography (TTE) has been restricted in patients after cardiac surgery due to reported poor image quality. The authors hypothesized that the hemodynamic state could be evaluated in a high proportion of patients at repeated intervals after cardiac surgery.DesignProspective observational study.SettingTertiary university hospital.ParticipantsThe study comprised 51 patients aged 18 years or older presenting for cardiac surgery.InterventionsPatients underwent TTE before surgery and at 3 time points after cardiac surgery. Images were assessed offline using an image quality scoring system by 2 expert observers. Hemodynamic state was assessed using the iHeartScan protocol, and the primary endpoint was the proportion of limited TTE studies in which the hemodynamic state was interpretable at each of the 3 postoperative time points.Measurements And Main ResultsHemodynamic state interpretability varied over time and was highest before surgery (90%) and lowest on the first postoperative day (49%) (p<0.01). This variation in interpretability over time was reflected in all 3 transthoracic windows, ranging from 43% to 80% before surgery and from 2% to 35% on the first postoperative day (p<0.01). Image quality scores were highest with the apical window, ranging from 53% to 77% across time points, and lowest with the subcostal window, ranging from 4% to 70% across time points (p< 0.01).ConclusionsHemodynamic state can be determined with TTE in a high proportion of cardiac surgery patients after extubation and removal of surgical drains.Copyright © 2017 Elsevier Inc. All rights reserved.

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