Kim Soo-Jin, Park Sin-Ae, Song Jinyoung, Shim Woo Sub, Choi Eun Young, Lee Sang Yoon
Department of Pediatric Cardiology, School of Medicine, Konkuk University, 4-12 Hwayng-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
Pediatr Cardiol. 2013 Feb;34(2):240-4. doi: 10.1007/s00246-012-0423-4. Epub 2012 Jul 13.
Routine use of intraoperative transesophageal echocardiography (TEE) is a safe monitoring and diagnostic method during pediatric congenital cardiac surgery. However, the question of whether intraoperative TEE is accurate and cost effective for patients with tetralogy of Fallot (TOF) has not been raised. This study aimed to analyze the cost-benefit of routine TEE during the repair of TOF. The medical records, including TEE results, for patients who underwent correction of TOF between January 1997 and June 2007 were reviewed and retrospectively analyzed. Intraoperative TEE was performed for 340 patients (85 %). Residual problems were detected in 17.9 % (61/340), and a return to bypass was needed for 10 % (34/340) of the patients. The degree of agreement between the intraoperative TEE and early postoperative transthoracic echocardiography (TTE) was relatively high. Surgeons with less surgical experience more frequently used intraoperative TEE (p = 0.007) and performed repeat bypass surgery at a higher rate (p = 0.00). Even relatively unskilled surgeons might be able to achieve surgical outcomes similar to those of experienced surgeons using intraoperative TEE. By avoiding late surgical revision, the possible cost savings were estimated to be 1,726,000 Korean won (US$1,489) per TEE examination. Intraoperative TEE can be used as a tool for surgeons in making decisions in the operating room. In addition, intraoperative TEE decreased the frequency of reoperations and postoperative interventions. The results of this study demonstrate that routine intraoperative TEE during repair of TOF was both clinically beneficial and cost effective.
术中经食管超声心动图（TEE）的常规应用是小儿先天性心脏病手术期间一种安全的监测和诊断方法。然而，术中TEE对于法洛四联症（TOF）患者是否准确且具有成本效益的问题尚未被提出。本研究旨在分析TOF修复术中常规TEE的成本效益。回顾并回顾性分析了1997年1月至2007年6月期间接受TOF矫正手术患者的病历，包括TEE结果。340例患者（85%）进行了术中TEE检查。17.9%（61/340）的患者检测到残余问题，10%（34/340）的患者需要再次进行体外循环。术中TEE与术后早期经胸超声心动图（TTE）之间的一致性程度相对较高。手术经验较少的外科医生更频繁地使用术中TEE（p = 0.007），且再次进行体外循环手术的比例更高（p = 0.00）。即使是相对不熟练的外科医生使用术中TEE也可能获得与经验丰富的外科医生相似的手术效果。通过避免后期手术翻修，估计每次TEE检查可能节省成本1726000韩元（1489美元）。术中TEE可作为外科医生在手术室进行决策的工具。此外，术中TEE降低了再次手术和术后干预的频率。本研究结果表明，TOF修复术中常规应用术中TEE在临床和成本效益方面均有益处。
