Safety and Benefit of Transesophageal Echocardiography in Liver Transplant Surgery: A Position Paper From the Society for the Advancement of Transplant Anesthesia (SATA)
- 1 August 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 26 (8), 1019-1029
- https://doi.org/10.1002/lt.25800
Abstract
More anesthesiologists are routinely using transesophageal echocardiography (TEE) during liver transplant surgery, but the effects on patient outcome are unknown. Transplant anesthesiologists are therefore uncertain if they should undergo additional training and adopt TEE. In response to these clinical questions, the Society for the Advancement of Transplant Anesthesia appointed experts in liver transplantation and who are certified in TEE to evaluate all available published evidence on the topic. The aim was to produce a summary with greater explanatory power than individual reports to guide transplant anesthesiologists in their decision to use TEE. An exhaustive search recovered 51 articles of uncontrolled clinical observations. Topics chosen for this study were effectiveness and safety because they were a major or minor topic in all articles. The pattern of clinical use was a common topic and was included to provide contextual information. Summarized observations showed effectiveness as the ability to make a new and unexpected diagnosis and to direct the choice of clinical management. These were reported in each stage of liver transplant surgery. There were observations that TEE facilitated rapid diagnosis of life-threatening conditions difficult to identify with other types of monitoring commonly used in the operating room. Real-time diagnosis by TEE images made anesthesiologists confident in their choice of interventions, especially those with a high risk of complications such as use of anticoagulants for intracardiac thrombosis. The summarized observations in this systematic review suggest that TEE is an effective form of monitoring with a safety profile similar to that in cardiac surgery patients.This publication has 58 references indexed in Scilit:
- Transoesophageal Echocardiography for Monitoring Liver Surgery: Data from a Pilot StudyCardiology Research and Practice, 2012
- Oesophageal perforation complicating intraoperative transoesophageal echocardiography: suspicion can save livesInteractive CardioVascular and Thoracic Surgery, 2010
- Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and managementLiver Transplantation, 2010
- The role of trans-oesophageal echocardiography for perioperative cardiovascular monitoring during orthotopic liver transplantationLiver Transplantation, 2006
- Cardiovascular collapse due to massive pulmonary thromboembolism during orthotopic liver transplantationJournal of Clinical Anesthesia, 2006
- Dynamic left ventricular outflow tract obstruction in an orthotopic liver transplant recipientLiver Transplantation, 2005
- Intracardiac thrombus formation and pulmonary thromboembolism immediately after graft reperfusion in 7 patients undergoing liver transplantationLiver Transplantation, 2001
- Intraoperative transesophageal echocardiography in orthotopic liver transplantation in a patient with hypertrophic cardiomyopathyJournal of Clinical Anesthesia, 1995
- TRANSESOPHAGEAL ECHOCARDIOGRAPHY REVEALS AN UNUSUAL CAUSE OF HEMODYNAMIC COLLAPSE DURING ORTHOTOPIC LIVER TRANSPLANTATION—TWO CASE REPORTSTransplantation, 1995
- Right Heart Dysfunction, Pulmonary Embolism, and Paradoxical Embolization during Liver TransplantationAnesthesia & Analgesia, 1989