Cardiac Anesthesia Intraoperative Interpretation Accuracy of Transesophageal Echocardiograms: A Review of the Current Literature and Meta-Analysis

Figures & data

Figure 1 Study flow chart.

Table 1 Publications Included in the Systematic Review

Authors	Year	Objective	Methods
Bick et al^Citation45	2013	To compare expert and novice performance of simulated TEE exams	TEE exams evaluated by blinded raters using a standardized assessment
Hahn et al^Citation39	2013	To outline current guidelines for TEE examinations	Outline general guidelines, and guidelines for comprehensive TEE exams and imaging specific cardiac structures
Konstadt et al^Citation47	1996	To measure physician competence in TEE	Written exam was administered to both anesthesia faculty and residents
Mathew et al^Citation4	2002	To evaluate agreement of TEE amongst cardiac anesthesiologists and primary echocardiographers. Measurements included left ventricular area change. Cardiac anesthesiologists interpreted TEE intraoperatively.	CQI program evaluated TEE examinations
Miller et al^Citation43	2001	To evaluate intraoperative accuracy of cardiac anesthesiologists after revision of TEE exam. The study examined size of the heart chambers, FAC, and degree of stenosis or insufficiency of heart valves.	Interpretations were compared to evaluation by cardiology expert review
Mishra et al^Citation41	1998	To assess safety and reliability of TEE during cardiac surgery. The study examined left ventricle regional wall motion, valve function, and ventricle function. Cardiac anesthesiologists interpreted TEE intraoperatively.	Comparison of interpretation by anesthesiologist and analysis by cardiologist
Rafferty et al^Citation40	1993	To evaluate 846 TEE procedures	Two software packages used to evaluate TEE
Sawasdiwipachai et al^Citation46	2022	To determine success rate in first 20 intraoperative TEEs in anesthesiologist trainees	TEE studies performed by trainees were reviewed by certified reviewers
Sloth et al^Citation44	2001	To determine whether TEE is beneficial during pediatric cardiac surgery	Intraoperative TEE was performed on 532 consecutive children

Table 2 Results of Transesophageal Echocardiogram Results in Systematic Review

Authors	N-Cardiac Anesthesiologists	A-Number of TEEs Interpreted	% Correctly Interpreted	# of Correct TEEs	Total TEEs	Total Average % Correct
Mathew et al^Citation4	10	154	83%	2045	2464
Miller et al^Citation43	8	131	79%	1242	1572
Mishra et al^Citation41	N/A*	3846	87%	3620	4161
				6907	8197	84.26%

Note: *Number of cardiac anesthesiologists was not mentioned.

Bick JS, Jr DS, Kennedy JD, et al. Comparison of expert and novice performance of a simulated transesophageal echocardiography examination. Simul Healthc. 2013;8(5):329–334. PMID: 24030477. doi:10.1097/SIH.0b013e31829068df

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Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921–964. PMID: 23998692. doi:10.1016/j.echo.2013.07.009

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Konstadt SN, Reich DL, Rafferty T. Validation of a test of competence in transesophageal echocardiography. J Cardiothorac Vasc Anesth. 1996;10(3):311–313. PMID: 8725408. doi:10.1016/s1053-0770(96)80088-7

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Mathew JP, Fontes ML, Garwood S, et al. Transesophageal echocardiography interpretation: a comparative analysis between cardiac anesthesiologists and primary echocardiographers. Anesth Analg. 2002;94(2):302–309. PMID: 11812688. doi:10.1097/00000539-200202000-00013

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Miller JP, Lambert AS, Shapiro WA, Russell IA, Schiller NB, Cahalan MK. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists. Anesth Analg. 2001;92(5):1103–1110. PMID: 11323329. doi:10.1097/00000539-200105000-00005

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Mishra M, Chauhan R, Sharma KK, et al. Real-time intraoperative transesophageal echocardiography--how useful? Experience of 5016 cases. J Cardiothorac Vasc Anesth. 1998;12(6):625–632. PMID: 9854658. doi:10.1016/s1053-0770(98)90232-4

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Rafferty T, LaMantia KR, Davis E, et al. Quality assurance for intraoperative transesophageal echocardiography monitoring: a report of 846 procedures. Anesth Analg. 1993;76(2):228–232. PMID: 8424496. doi:10.1213/00000539-199302000-00005

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Sawasdiwipachai P, Thanasriphakdeekul S, Raksamani K, Vacharaksa K, Chaithiraphan V. Learning curve for the acquisition of 20 standard two-dimensional images in advanced perioperative transesophageal echocardiography: a prospective observational study. BMC Med Educ. 2022;22(1):412. PMID: 35637456; PMCID: PMC9153196. doi:10.1186/s12909-022-03280-3

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Sloth E, Pedersen J, Olsen KH, Wanscher M, Hansen OK, Sørensen KE. Transoesophageal echocardiographic monitoring during paediatric cardiac surgery: obtainable information and feasibility in 532 children. Paediatr Anaesth. 2001;11(6):657–662. PMID: 11696140. doi:10.1046/j.1460-9592.2001.00737.x

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