Utilization of intraoperative transesophageal echocardiography during repair of congenital cardiac defects: A survey of North American Centers

Background: Intraoperative transesophageal echocardiography (TEE) has been increasingly utilized during repair of congenital cardiac defects. Hypothesis: The aim of this study was to assess the practice of TEE in this setting. Methods: A survey was sent to 70 centers in the United States and Canada; replies were obtained from 65 centers (93%). Responses were grouped into four categories: (1) Performance of intraoperative echocardiography, (2) performance practices, (3) equipment and probe issues, (4) billing and reimbursement. Data were available from all responding centers unless specified below. Results: All responding centers employed intraoperative echocardiography, with 98% employing TEE. All responding centers employed intraoperative echocardiography. The majority of centers (72%) utilized intraoperative echocardiography in all cases or all open cases except atrial septal defects, while the remainder employed it selectively. The average duration of TEE experience at responding centers was 6.1 years. Transesophageal echocardiography was primarily the responsibility of cardiologists, with most centers having individuals meeting published TEE training guidelines. The large majority of centers performed both pre- and postbypass TEE studies. Equipment and probes were widely available. All centers disinfected the TEE probe between studies, but for longer times than recommended. Conclusion: Utilization of intraoperative TEE during surgery for congenital heart disease is widespread; the results of this survey may be useful to individual institutions as they evaluate their utilization of intraoperative echocardiography.