Transesophageal echocardiography and pulmonary artery catheter use and short-term outcomes in patients undergoing coronary artery bypass surgery: a multi-center retrospective study

Background — While the use of transesophageal echocardiography (TEE) or pulmonary artery catheters (PAC) has been studied in coronary artery bypass grafting (CABG), outcomes associated with their concurrent use remain understudied. Therefore, we sought to investigate the association between intraoperative TEE, with or without PAC, and patient outcomes following isolated CABG.

Methods — This population-based study included adults (≥ 18 years old) undergoing isolated CABG from 2009 to 2019 across 11 Ontario centers using administrative databases. The primary outcome was a composite of 30-day mortality and major complications. Multivariable regression with general estimating equations was performed, adjusting for patient, surgical, and hospital factors. Subgroup analyses by surgical urgency and left ventricular ejection fraction (LVEF), and a weighted propensity score sensitivity analysis were done.

Results — Among 70,065 patients undergoing CABG, 45.5% received TEE and 70.7% PAC. PAC alone (45.2%) was the most common, followed by TEE + PAC (25.5%). Adjusted analyses revealed a higher risk of the primary outcome for TEE + PAC (aRR 1.18; 95% CI, 1.11–1.25) and PAC alone (aRR 1.05; 95% CI, 1.02–1.09), while TEE alone was not significant (aRR 1.06; 95% CI, 0.99–1.14) versus neither modality. PAC alone was associated with lower 30-day mortality (aRR 0.67; 95% CI, 0.49–0.93) versus neither modality. Sensitivity analyses were consistent. TEE + PAC was associated with a higher risk of the primary outcome in elective and emergent surgeries versus neither modality. For LVEF ≥ 35%, both TEE + PAC and PAC alone were linked to higher risk; no differences were observed in LVEF < 35%. When compared to TEE alone, TEE + PAC was associated with a lower risk of 30-day mortality (aRR 0.59; 95% CI, 0.36–0.96).

Conclusions — Combined TEE + PAC use in CABG was associated with higher adverse outcomes versus neither modality. PAC use was associated with mixed findings depending on the comparator. Prospective studies are needed to identify subgroups benefiting from specific modalities and evaluate longer-term outcomes.