INTRODUCTION
Risk scoring systems for cardiac surgery patients first became popular
with the Parsonnet score to calculate mortality risk
[1]. Though subsequent evolution
allows for calculation of postoperative morbidity
[2] and reflects advances in our
understanding of the patient’s determinants for risk
[3], these risk scoring systems remain
imperfect [4,
5].
It is now recognized that cardiac performance during diastole influences
morbidity [6]
[7]. We have previously shown that, in
patients undergoing coronary artery bypass (CAB) and/or Aortic Valvular
surgery, diastolic function evaluated by preoperative Transthoracic
Echocardiography (TTE) predicts hospital stay in patients with varying
degrees of systolic function [8]. That
study did not address the predictive capacity of transesophageal
echocardiography (TEE), in which parameters of LV’s nonsystolic function
(e.g. LA max volume) are much less reliably
[9-11] or less practically
[12,
13] obtained.
This is a prospective cohort study involving subjects with normal
systolic function undergoing CAB surgery to evaluate the association
between intraoperative TEE metrics of LV performance during diastole and
postoperative outcomes. The TEE algorithm depends on a limited number of
metrics of performance during diastole and is validated to predict 5
year composite outcomes following CAB
[14]. We hypothesized that the
algorithm would be associated with duration of hospitalization after
CAB.