Intraoperative Changes in Regional Wall Motion: Can Postoperative Coronary Artery Bypass Graft Failure Be Predicted

Journal of Cardiothoracic and Vascular Anesthesia, 04/10/2012

De Mey N et al. – In this retrospective study, regional wall motions abnormalities (RWMAs) detected with transesophageal echocardiography (TEE) were of limited value to predict early postoperative coronary artery bypass graft (CABG) failure.

Methods

  • Five thousand nine hundred ninety-eight patients who underwent coronary artery bypass graft (CABG) surgery.
  • An evaluation of RWMAs recorded with intraoperative TEE before and after cardiopulmonary bypass (CPB) in patients who had coronary angiography for suspected postoperative myocardial ischemia based on electrocardiogram (ECG), CK-MB, troponin T, hemodynamic compromise, low cardiac output, and malignant ventricular arrhythmia.
  • Sensitivity, specificity, positive and negative predictive values, odds ratio, 95% confidence interval, and chi-square analysis were used.

Results

  • Thirty-nine patients (0.7%) underwent early coronary angiography for the suspicion of early graft dysfunction.
  • Of the 32 patients with diagnosed early graft dysfunction, 5 patients (15.6%) had shown new intraoperative RWMAs as detected by TEE, 21 patients (65.6%) had no new RWMAs, no report was available in 5 patients (15.6%), and 1 examination (3.1%) was excluded because of poor imaging quality.
  • The sensitivity of TEE to predict graft failure was 15.6%, the specificity was 57.1%, and the positive predictive and negative values were 62.5% and 12.9%, respectively.
  • The odds ratio and 95% confidence interval was 0.1190 (0.0099-1.4257) when TEE was positive compared with coronary angiography.
  • No association was found between new RWMAs detected with TEE and graft failure as documented with coronary angiography (p=0.106).

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