Con: All Off-Pump Coronary Artery Bypass Graft Surgeries Should Not Include Intraoperative Transesophageal Echocardiography Assessment

摘要

As clinicians debate whether or not all off-pump coronary artery bypass (OPCAB) surgeries should use intraoperative transesophageal echocardiography (TEE) assessment, it brings to mind an American cowboy movie starring Clint Eastwood. The movie The Good, the Bad and the Ugly tells a story of 3 cowboys: one good, one bad, and one ugly. The terms good, bad, and ugly are fitting to describe the use of TEE during OPCAB surgery.The use of TEE during OPCAB surgery was discussed in The American College of Cardiology (ACC), American Heart Association (AHA), and American Society of Echocardiography (ASE) 2003 Guideline Update for the Clinical Application of Echocardiography. This document updated the (older) ITEE guidelines published by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists in 1996. The ACC/AHA/ASE 2003 guidelines gave TEE a class IIb recommendation for the "evaluation of regional myocardial function during and after OPCAB procedures."