Intraoperative and intraprocedural use of three-dimensional transesophageal echocardiography: An international EACTAIC survey of cardiac surgical centers

Objective To assess the intraoperative use of three-dimensional transesophageal echocardiography (3D TEE) in cardiac surgical centers, we created a survey aimed at evaluating the availability of equipment, the use of 3D TEE for specific surgical and interventional procedures and single image modalities. Finally, we asked to identify the perceived impact on patient's management and current limitations to its routine use. Design Multiple-choice 25-questions online survey submitted to the members of the European Association of Cardiothoracic Anesthesia and Intensive Care (EACTAIC) on December 6th, 2021 and closed on January 31st, 2022. Setting Online survey. Participants Registered EACTAIC members in 2021. Interventions None. Measurements and Main Results A total of 239 respondents from 44 different countries took part in the survey (27% of total 903 EACTAIC members). Most respondents (59%) were TEE certified by National Board of Echocardiography (NBE), European Association of Cardiovascular Imaging (EACVI/EACTAIC) or had a national certificate. Sixty-eight percent of respondents had no formal 3D TEE training. Eight percent of respondents had no 3D machines. While 40% had one for each operating room, 33% had only one for the entire operating room block. 3D TEE was performed most frequently in more than 67% of cases for mitral valve (MV) surgery and in more than 54% of cases for mitral- and tricuspid clips, aortic valve- (AV), tricuspid valve- (TV) and aortic surgery. Conclusion Current guidelines suggest integrating 3D TEE in all comprehensive examinations. Our survey reports that intraoperative 3D TEE was used in the majority of mitral valve surgery and only half of other valve surgeries and transcatheter procedures. Its use may be explained by the availability of 3D machines, trained personnel and limited time to perform TEE in the operating room. Educational initiatives for training in 3D TEE may further increase its routine use.