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Objective: With the increased use of intraoperative transesophageal echocardiography (TEE), patent foramen ovale (PFO) has become a common finding during routine coronary artery bypass graft (CABG) surgery. This survey was designed to study potential differences in the management of intraoperatively diagnosed PFO., Design: A written survey., Setting: US university and community hospitals., Participants: The authors randomly selected 50% of US cardiac surgeons listed in the Cardiothoracic Surgery Network Database (n = 734)., Interventions: A written survey was mailed to the participants. The survey questions included respondents' use of TEE during CABG surgery, examination for a PFO with TEE, and management of intraoperatively diagnosed PFO in the CABG surgery., Measurements and Main Results: Overall, 64% of individuals (468/734) responded to the survey request. TEE is available in the primary institution of 98.6% of respondents and used to search for a PFO in approximately one third of all CABG surgeries. During planned on-pump CABG surgery, 27.9% of respondents always close an intraoperatively diagnosed PFO, whereas 10.2% of respondents never close an intraoperatively diagnosed PFO. During planned off-pump CABG surgery, 27.6% of surgeons never change their plan, and 11% of respondents always convert the procedure to on-pump CABG to close the PFO. The majority of respondents decide whether to close a PFO based on the size of the PFO, the right atrial pressure, and a history of possible paradoxical embolism., Conclusions: In the United States, TEE is used extensively during CABG surgery. There is significant variability in how intraoperatively diagnosed PFO is managed during CABG surgery.

Unlabelled: Low gastric intramucosal pH (pHi) and an increased gastric-arterial PCO2 difference (CO2 gap) are markers of tissue hypoperfusion. Perfluorocarbons (PFCs) have a large oxygen-carrying capacity and release oxygen when encountering low tissue oxygen tension. Nine cardiac surgical patients instrumented for gastric tonometry were enrolled as part of a multicenter, randomized, single-blinded study of a PFC emulsion (perflubron emulsion [Oxygent]). Patients were randomized to receive PFC (n = 4) or placebo (n = 5) after intraoperative autologous blood harvesting by acute normovolemic hemodilution. At baseline there were no intergroup differences in tonometric-, hemodynamic-, or oxygen delivery-derived variables, e.g., Control group (pHi, 7.37 +/- 0.06; CO2 gap, 6.4 +/- 1.3 mm Hg) versus PFC group (pHi, 7.38 +/- 0.06; CO2 gap, 6.7 +/- 1.5 mm Hg). After acute normovolemic hemodilution, pHi was significantly lower (P < 0.01) in the Control group (7.22 +/- 0.25) than in the PFC group (7.44 +/- 0.25), and CO2 gap was significantly higher (P < 0.001) in the Control group (23.4 +/- 5.1 mm Hg) than in the PFC group (1.8 +/- 0.8 mm Hg). These differences in tonometric variables persisted during surgery. The PFC group showed a significantly (P < 0.007) shorter time to first bowel movement postoperatively (2.0 +/- 0.8 vs 5.4 +/- 1.6 days). Time to consumption of solid food was also shorter in the PFC group and almost achieved statistical significance (P = 0.056)., Implications: This study suggests that the administration of perflubron emulsion prevents gastrointestinal tract ischemia in cardiac surgical patients and may preserve postoperative gastrointestinal tract function.