PROCEDURAL STAFFING IN TRANSESOPHAGEAL ECHOCARDIOGRAPHY-GUIDED VERSUS 3D INTRACARDIAC ECHOCARDIOGRAPHY-GUIDED LEFT ATRIAL APPENDAGE OCCLUSION: AN ANALYSIS OF INTRAPROCEDURAL RECORDS
Author(s)
Rayan S. El-Zein, MSc, DO1, Reynaldo Vazquez, MA2, Sanjay Verma, MPharm, MSc3, Andrew Volio, DO1, Zeryab Khan, DO1, Carlos E. Sanchez, DO1, Steven J. Yakubov, MD1, Sreedhar R. Billakanty, MD1, Auroa Badin, MD1, Anish K. Amin, MD1.
1OhioHealth, Columbus, OH, USA, 2Medical Office, Philips, Cambridge, MA, USA, 3Medical Office, Philips, Amersham, United Kingdom.
1OhioHealth, Columbus, OH, USA, 2Medical Office, Philips, Cambridge, MA, USA, 3Medical Office, Philips, Amersham, United Kingdom.
OBJECTIVES: The imaging toolkit for left atrial appendage occlusion (LAAO) now includes 3D intracardiac echocardiography (3D-ICE). Although a growing body of evidence points to 3D-ICE as a safe alternative with reduced dependency on general anesthesia compared to traditional transesophageal echocardiography (TEE), the resulting intraoperative operational impacts remain under-quantified. Our objective was to compare intraprocedural staffing patterns associated with TEE versus 3D-ICE in LAAO procedures.
METHODS: This retrospective analysis compared anesthesia modality and intraoperative staff configurations for consecutive patients undergoing LAAO with TEE or Philips VeriSight Pro 3D-ICE within the OhioHealth system (2021-2024). Concomitant procedures, urgent/emergency admissions, mandated or mixed-imaging modalities, or incomplete records were excluded. Groups were balanced according to CHA₂DS₂-VASc scores, demographics, and other clinical characteristics via propensity matching. Data were extracted from electronic health, billing, and intraprocedural records.
RESULTS: Among 400 patients (200 per group), general anesthesia was used in 86.5% of TEE cases versus 0.5% for 3D-ICE (P<.001). In 96% of TEE cases, at least one ancillary specialist (anesthesiologist or imaging cardiologist) was present, versus <1% with 3D-ICE. In 76% of TEE cases, the implanter was accompanied by both specialists. Physician count averaged 2.73 for TEE versus 1.01 for 3D-ICE (Δ1.72; [1.65-1.79]; P<.001). Mean participation of circulator nurses (TEE:1.24, 3D-ICE:1.41; P=.003) and scrub technologists (TEE:0.88, 3D-ICE:1.00; P<.001) was higher with 3D-ICE. With no significant differences in other roles, overall headcount was lower with 3D-ICE (TEE:5.97, 3D-ICE:4.52; Δ1.45; [1.29-1.62]; P<.001).
CONCLUSIONS: We quantified staffing differences between TEE and 3D-ICE within a real-world LAAO program. Each modality was associated with distinct intraprocedural team configurations. 3D-ICE shifts intraoperative staffing from a physician-heavy model observed with TEE to a leaner team that relies more on nurse and allied-health support. For healthcare environments facing severe specialist shortages, this shift in resource allocation can present an opportunity to expand access to LAAO.
METHODS: This retrospective analysis compared anesthesia modality and intraoperative staff configurations for consecutive patients undergoing LAAO with TEE or Philips VeriSight Pro 3D-ICE within the OhioHealth system (2021-2024). Concomitant procedures, urgent/emergency admissions, mandated or mixed-imaging modalities, or incomplete records were excluded. Groups were balanced according to CHA₂DS₂-VASc scores, demographics, and other clinical characteristics via propensity matching. Data were extracted from electronic health, billing, and intraprocedural records.
RESULTS: Among 400 patients (200 per group), general anesthesia was used in 86.5% of TEE cases versus 0.5% for 3D-ICE (P<.001). In 96% of TEE cases, at least one ancillary specialist (anesthesiologist or imaging cardiologist) was present, versus <1% with 3D-ICE. In 76% of TEE cases, the implanter was accompanied by both specialists. Physician count averaged 2.73 for TEE versus 1.01 for 3D-ICE (Δ1.72; [1.65-1.79]; P<.001). Mean participation of circulator nurses (TEE:1.24, 3D-ICE:1.41; P=.003) and scrub technologists (TEE:0.88, 3D-ICE:1.00; P<.001) was higher with 3D-ICE. With no significant differences in other roles, overall headcount was lower with 3D-ICE (TEE:5.97, 3D-ICE:4.52; Δ1.45; [1.29-1.62]; P<.001).
CONCLUSIONS: We quantified staffing differences between TEE and 3D-ICE within a real-world LAAO program. Each modality was associated with distinct intraprocedural team configurations. 3D-ICE shifts intraoperative staffing from a physician-heavy model observed with TEE to a leaner team that relies more on nurse and allied-health support. For healthcare environments facing severe specialist shortages, this shift in resource allocation can present an opportunity to expand access to LAAO.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MT1
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas, Surgery, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)