Impact Of Transesophageal Echocardiography-guided Hemodynamic Optimization On Fast-track Recovery After Cardiac Surgery.

Perioperative volume misclassification and cardiac dysfunction often hinder fast-track recovery following cardiac surgery. This retrospective cohort study evaluated whether intraoperative transesophageal echocardiography (TEE)-guided hemodynamic optimization was associated with improved fast-track outcomes. Seventy-two adult patients undergoing cardiac surgery received either TEE-guided optimization (n = 34) or standard care (n = 38). The intervention involved goal-directed hemodynamic management based on TEE phenotyping of volume status and cardiac function at predefined intraoperative time points, including post-induction, prior to cardiopulmonary bypass, during weaning from bypass, and before chest closure. Clinical decisions were guided by predefined objective criteria, including left ventricular end-diastolic area and stroke volume responsiveness for fluid management, and ejection fraction and regional wall motion abnormalities for inotropic support. Inverse probability of treatment weighting was used to adjust for baseline imbalances. TEE-guided optimization was associated with shorter time to extubation and reduced intensive care unit length of stay compared with standard care. The intervention group also showed improved early postoperative perfusion profiles without an observed increase in major complications. These findings suggest that intraoperative TEE-guided hemodynamic optimization may support fast-track recovery after cardiac surgery, although larger prospective studies are needed to confirm these results.