Cardiothoracic & vascular anesthesia
Surgical Volume and Outcomes of Intraoperative Transesophageal Echocardiography in Coronary Artery Bypass Grafting
Authors' conclusion
In isolated CABG, intraoperative TEE was associated with survival benefit at low- and medium-volume hospitals, particularly in patients with complex coronary disease or hemodynamic instability, but not at high-volume hospitals.
Study context
- Population
- Patients aged 18 years or older who underwent isolated coronary artery bypass graft (CABG) surgery between July 1, 2014, and June 30, 2022, at low, medium and high surgical volume hospitals61.8% received transesophageal echocardiography (TEE)
- Participants
- 1,266,055 patients
- Exposure
- Intraoperative TEE vs without TEE during isolated CABG
- Outcome
- Mortality within 30 days of surgery
- Follow-up
- 30 days
Methodological details2-stage, target trial emulation, stratified by hospital surgical volume, Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, Data analysis August 8, 2023, to December 15, 2024
- 2-stage
- Target trial emulation
- Stratified by hospital surgical volume
- STS Adult Cardiac Surgery Database
- Data analysis August 8, 2023, to December 15, 2024
Main finding
As reported in the abstract
30-day mortality by hospital surgical volume (subgroup)
TEE
- Low volume
- 2.47%
- Medium volume
- 2.09%
- High volume
- 1.72%
Without TEE
- Low volume
- 2.94%
- Medium volume
- 2.34%
- High volume
- 1.77%
Low volume
TEE2.47%
Without TEE2.94%
Medium volume
TEE2.09%
Without TEE2.34%
High volume
TEE1.72%
Without TEE1.77%
TEE vs Without TEEOdds ratio (95% CI)P value
Low surgical volume
0.83(0.78–0.89)
P < 0.001Medium surgical volume
0.89(0.85–0.93)
P < 0.001High surgical volume
0.97(0.91–1.03)
P = 0.48Observational data: associations, not effects.
Further findings
Patient subpopulations at low and medium volume hospitals (subgroup)
- Greatest TEE survival benefit with >50% (vs ≤50%) left-main stenosis, ≥3 (vs <3) diseased coronaries, and preoperative inotropic requirement
Original publication
Surgical Volume and Outcomes of Intraoperative Transesophageal Echocardiography in Coronary Artery Bypass Grafting. JAMA Netw Open. Published 1 October 2025. doi:10.
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