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The Journal of Cardiovascular Surgery 2020 Sep 10

DOI: 10.23736/S0021-9509.20.11427-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Trans-esophageal echocardiography during endovascular procedures for thoracic aorta diseases: sensitivity and specificity analysis

Petroula N. NANA 1 , Alexabdros G. BROTIS 2, Vassiliki TSOLAKI 3, Konstantinos SPANOS 1, Konstantinos MPATZALEXIS 1, Epaminondas ZAKYNTHINOS 3, Athanasios D. GIANNOUKAS 1, George N. KOUVELOS 1

1 Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; 2 Department of Neurosurgery, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; 3 Intensive Care Unit, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece



INTRODUCTION: The widespread use of endovascular repair in thoracic aorta (TEVAR) pathologies has ameliorated post-operative outcomes. This meta-analysis was designed to investigate the intra-operative use of transesophageal echocardiography (TEE) compared to angiography in patients undergoing TEVAR.
EVIDENCE ACQUISITION: The meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until November 30, 2019. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence and the summary of findings for each of the included outcomes.
EVIDENCE SYNTHESIS: The final analysis included 7 articles (183 patients). All patients underwent TEVAR using intra-operative TEE and angiography. The sensitivity and specificity rates of entry points were 0.624 (95% CI 0.145-0.97) and 0.377 (95% CI 0.029-0.856), respectively. Regarding the detection of adequate guidewire advancement, the sensitivity was 0.778 (95% CI 0.288-939) and specifity 0.346 (95% CI 0.019-0.844). TEE could detect endograft incomplete deployment within acceptable rates of sensitivity and specifity, estimated at 0.616 (95% CI 0.141-0.971) and 0.365 (95% CI 0.028-0.845), respectively. The intra-operative detection of endoleaks presented a sensitivity estimated at 0.875 (0.51-0.998) and specificity at 0.698 (95% CI 0.284-0.904).
CONCLUSIONS: Despite the limitations of this analysis, TEE may be evaluated in the current endovascular era, as a useful tool, providing adequate information, on graft deployment and early endoleaks.


KEY WORDS: Transesophageal echocardiography; Endovascular thoracic aortic repair; imaging, meta-analysis

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