Cardiopulmonary Bypass Surgery, Left Ventricular Dysfunction
Conditions
Keywords
Transesophageal Echocardiography, Left Ventricular Ejection Fraction, Visual Estimation, Eyeballing Method, Cardiac Surgery, Ejection Fraction Assessment, Intraoperative Monitoring, Decannulation, Cardiopulmonary Bypass
Brief summary
This study aims to evaluate the diagnostic performance of the cardiovascular surgeon's visual estimation of LV function before decannulation following cardiopulmonary bypass, using TEE results as the reference standard.
Detailed description
The fundamental rationale for conducting this study is that the moment of decannulation after cardiopulmonary bypass (CPB) represents one of the most critical stages in cardiac surgery in terms of patient outcomes. At this stage, inadequate left ventricular (LV) function (dysfunction) can lead to severe hemodynamic deterioration, increased complications, and a higher risk of mortality. Therefore, accurately and rapidly assessing LV function just before separation from CPB is of vital importance. Although Transesophageal Echocardiography (TEE) is currently the most reliable and objective method, it requires specialized equipment, training, and time. On the other hand, experienced cardiac surgeons often make a visual estimation based on the observable physical appearance of the heart (such as its color, contractility, and fullness), relying on their many years of experience. This visual assessment is extremely fast and practical; however, it is subjective, and its reliability has not been clearly established scientifically. Thus, the primary rationale for this study is to fill this gap in the scientific literature and determine how well the surgeon's quick, experience-based visual estimation aligns with the objective findings of TEE, the gold-standard method. The main objective of the study is to evaluate the diagnostic performance of the cardiovascular surgeon's visual estimation of LV function before decannulation following cardiopulmonary bypass, using TEE results as the reference standard. In other words, it aims to statistically determine the agreement between the surgeon's practical visual assessment and the objective measurements provided by TEE, thereby offering a scientific basis for clinical decision-making by revealing the sensitivity and specificity limits of the surgeon's estimation, particularly in detecting critical conditions such as severe dysfunction.
Interventions
DIAGNOSTIC_TESTIntraoperative Left Ventricular Function Assessment
Left ventricular function will be assessed during the decannulation phase of cardiopulmonary bypass using two diagnostic methods: (1) visual estimation of ventricular contractility by the cardiac surgeon (eyeballing) and (2) objective measurement using intraoperative transesophageal echocardiography (TEE). No experimental procedure, medication, or additional intervention will be applied. Both assessments are part of standard intraoperative monitoring in cardiac surgery. Data from both methods will be collected simultaneously to compare accuracy, agreement, and diagnostic performance.
Sponsors
Ataturk University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 75 years * Scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CABG, valve surgery, or aortic surgery) * ASA physical status III-IV * Able and willing to provide written informed consent * Suitable for intraoperative transesophageal echocardiography (TEE)
Exclusion criteria
* Emergency surgery * Known severe preoperative left ventricular dysfunction (EF \< 30%) * Significant arrhythmias (e.g., atrial fibrillation) * Preoperative requirement for mechanical circulatory support (e.g., IABP) * Contraindications to TEE (esophageal pathology, bleeding risk, strictures) * Inability to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Agreement Between Surgeon Visual Estimation and TEE-Derived Left Ventricular Ejection Fraction | During the decannulation phase of cardiopulmonary bypass (intraoperative period) | This outcome evaluates the level of agreement between the cardiac surgeon's visual estimation (eyeballing) of left ventricular systolic function and the ejection fraction measured by intraoperative transesophageal echocardiography (TEE). Agreement will be quantified using statistical measures such as Cohen's kappa coefficient and correlation coefficients. Visual estimation categories (e.g., normal, moderately reduced, severely reduced) will be compared with corresponding TEE-derived EF classifications. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic Accuracy of Surgeon Visual Estimation for Detecting Reduced Left Ventricular Function | During the decannulation phase of cardiopulmonary bypass (intraoperative period) | This outcome measures the diagnostic performance of the surgeon's visual estimation in identifying reduced left ventricular systolic function, using TEE-derived ejection fraction as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy will be calculated for detecting clinically significant systolic dysfunction (e.g., EF \< 30% or EF \< 40%). |
| Prediction of Postoperative Hemodynamic Support Requirement | From intraoperative decannulation through 24 hours postoperatively | This outcome evaluates whether the surgeon's intraoperative visual assessment of left ventricular function predicts the need for postoperative hemodynamic support. Outcomes include the requirement for intra-aortic balloon pump (IABP), return to cardiopulmonary bypass, or initiation of high-dose inotropic therapy during or after separation from bypass. |
| Correlation Between Quantitative TEE Measurements and Surgeon Visual Estimation | During the decannulation phase of cardiopulmonary bypass | This outcome examines the correlation between TEE-derived quantitative parameters (ejection fraction, end-diastolic volume, end-systolic volume) and the categorical visual estimation provided by the cardiac surgeon (normal, moderately reduced, severely reduced). Correlation coefficients (Pearson or Spearman) will be calculated. |
Countries
Turkey (Türkiye)
Contacts
CONTACTMuhammed Enes Aydin, Associate Professor
CONTACTFiliz Albayrak, assistant doctor
PRINCIPAL_INVESTIGATORMuhammed Enes Aydın, Principal Investigator
Ataturk University Department of Anesthesiology and Reanimation
Outcome results
None listed