What is the clinical evidence from this study?

Study design: Cohort. Population: Planned isolated coronary artery bypass grafting (CABG) (n=1255860). Intervention: Intraoperative transesophageal echocardiography (TEE) vs. No intraoperative TEE. Primary outcome: Operative mortality (adjusted OR 0.95, 95% CI 0.91 to 0.99, p=0.025).

What does this research mean for the field?

Intraoperative transesophageal echocardiography during planned isolated coronary artery bypass grafting is associated with significantly lower operative mortality, particularly in higher-risk patients, and higher odds of unplanned valve procedures. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the association between intraoperative transesophageal echocardiography (TEE) during planned isolated coronary artery bypass grafting (CABG) and operative mortality as well as unplanned valve surgery.

August 17, 2026Journal of the American College of CardiologyOpen Access

Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery

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Key result

Intraoperative TEE during CABG linked to ~5% lower operative mortality vs no TEE.

adjusted OR 0.95
95% CI 0.91 to 0.99
P=0.025
n=1,255,860

Why the study?

The impact of intraoperative transesophageal echocardiography during isolated CABG on clinical decision making and associated outcomes is not well understood.

Does intraoperative transesophageal echocardiography (TEE) reduce operative mortality in patients undergoing planned isolated CABG?

Key Points

To evaluate the association between intraoperative transesophageal echocardiography (TEE) during planned isolated coronary artery bypass grafting (CABG) and operative mortality as well as unplanned valve surgery.
Conducted a retrospective cohort study using Society of Thoracic Surgeons Adult Cardiac Surgery Database records from 1,255,860 planned isolated CABG procedures across 1,218 centers between January 1, 2011, and June 30, 2019.
Compared outcomes between patients undergoing intraoperative TEE (n = 676,803; 53.9%) and those who did not, utilizing multivariable adjustment and propensity score matching (560,639 matched pairs).
Intraoperative TEE utilization increased over time from 39.9% in 2011 to 62.1% in 2019 (p trend <0.0001).
CABG patients receiving intraoperative TEE had significantly lower odds of operative mortality (adjusted OR: 0.95; 95% CI: 0.91 to 0.99; p = 0.025), with lower odds observed in high-risk patients (OR: 0.89; 95% CI: 0.83 to 0.95) and intermediate-risk patients (OR: 0.93; 95% CI: 0.87 to 0.99), but not in low-risk patients (OR: 0.99; 95% CI: 0.94 to 1.04; p interaction = 0.015).
Intraoperative TEE was associated with an increased rate of unplanned valve procedures (0.49% vs. 0.09%; adjusted OR: 4.98; 95% CI: 3.98 to 6.22; p < 0.0001).

Study Design

Type

Cohort (n=1,255,860)

Multicenter

Yes

Structured PICO

Does intraoperative transesophageal echocardiography (TEE) reduce operative mortality in patients undergoing planned isolated CABG?

Population

1,255,860 patients undergoing planned isolated coronary artery bypass grafting across 1,218 U.S. centers between 2011 and 2019.

Exposure

Intraoperative transesophageal echocardiography (TEE) during CABG

Comparator

No intraoperative TEE during CABG

Outcome

Operative mortality (all deaths during hospitalization or after discharge but before the end of the 30th postoperative day)hard clinical

Main Result

Odds Ratio: 0.95 (95% CI 0.91–0.99)

p-value: p=0.025

Limitations

The STS ACSD does not include information on TEE complications such as esophageal perforation.
Specific personnel performing the TEE and their training/certification are not captured in the database.
The observational nature of the study supports a lesser certainty of inference than a randomized trial.
Pre-operative surgeon intent is difficult to fully ascertain from a binary classification.
Ascertainment of mortality in the STS database may be incomplete for patients who die within 30 days of surgery but after hospital discharge.
STS ACSD does not include information on TEE complications such as esophageal perforation
Specific personnel performing the TEE and their training are not captured in the database
Observational nature supports lesser certainty of inference than a randomized trial
Pre-operative surgeon intent is difficult to fully ascertain from a binary classification
Ascertainment of mortality in the STS database may be incomplete for out-of-hospital deaths within 30 days

Discussion

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Implication

Intraoperative TEE during isolated CABG is associated with reduced operative mortality, particularly in high-risk patients, and increased identification of occult valvular disease leading to unplanned valve procedures.

Cite This Study

Metkus et al. (2021) conducted a cohort in Planned isolated coronary artery bypass grafting (CABG) (n=1,255,860). Intraoperative transesophageal echocardiography (TEE) vs. No intraoperative TEE was evaluated on Operative mortality (adjusted OR 0.95, 95% CI 0.91 to 0.99, p=0.025). Intraoperative transesophageal echocardiography during planned isolated CABG was associated with lower odds of operative mortality (adjusted OR 0.95) compared to no TEE.

synapsesocial.com/papers/6a827da4bfd4574fc2c83536 https://doi.org/10.1016/j.jacc.2021.04.064

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Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider