Intraoperative Echocardiography in Low-Risk CABG Surgery

Prior treatment

• Any CABG surgery with either "possible" or "definite" aortic intervention listed as a planned part of the procedure. plan for either definite or possible surgical intervention.
• Any CABG surgery with either "possible" or "definite" valve repair/replacement listed as a planned part of the procedure.
• Having undergone any previous cardiac surgeries (i.e. scheduled with a "REDO" modifier).
• Any of these three relative contraindication to TEE:
  • Esophageal varies
  • Gastric bypass surgery
  • Descending thoracic aortic aneurysm

Other illness

• Documented valve (aortic, mitral, tricuspid, or pulmonic) disease (stenosis or regurgitation) moderate or greater.
• Proximal/critical left main coronary disease (e.g. greater than or equal to 90% stenosis).
• Preexisting end-stage renal disease on hemodialysis
• Preexisting chronic kidney disease (CKD) stage 3, 4, or 5
• Stroke with residual focal neurological deficit(s) within 90 days of surgery
• Absolute contraindication to echocardiography defined as one or more of the following documented conditions:
  • Esophagectomy
  • Esophagogastrectomy
  • Esophageal trauma
• Severe pulmonary hypertension defined as:
  • Pulmonary arterial pressure ≥60 mmHg
  • Pulmonary vascular resistance (PVR) ≥3 Woods Units

Other

• Preexisting anomalous coronary arteries
• Any of the following presurgical, mechanical circulatory support devices:
  • Intraaortic balloon pump
  • Percutaneous right ventricular assist device (RVAD)
  • Impella
  • Extracorporeal membrane oxygenation (ECMO)
• Hemodynamic instability after induction and following placement of an endotracheal tube will be defined as one or more of the following events or scenarios:
  • Placement of an intraaortic balloon pump (IABP)
  • Initiation of venoarterial extracorporeal membrane oxygenation (VAECMO)
  • Placement of a right or left percutaneous mechanical circulatory support device
  • Initiation of epinephrine infusion at a dose ≥ 6 mcg/min for a duration ≥5 minutes
  • Initiation of norepinephrine at a dose ≥8 mcg/min for a duration ≥ minutes
  • Initiation of phenylephrine infusion at a dose ≥100 mcg/min for a duration ≥ minutes
  • Initiation of vasopressin infusion at a dose ≥0.04 units/min for a duration ≥ minutes

• Scheduled to undergo isolated CABG surgery at a hospital within the UPenn Health System
• Age ≥18 years
• Ejection fraction ≥50%
• Transthoracic echocardiography within one year of scheduled surgery date
• Left heart catheterization within one year of scheduled surgery date
• English language fluency or facilitated via language interpreter
• Able to provide informed consent either in English or via a language interpreter
• Willing to comply with all study procedures