Myocardial strain analysis provides additional and valuable information about left ventricular function, particularly in the perioperative setting with its dynamic changes in ventricular load conditions. This allows for earlier risk assessment and, if necessary, the initiation of faster and more targeted therapy. Unfortunately, conventional strain analysis using conventional methods currently takes approximately 5 minutes. However, this amount of time is often not available in a dynamically changing intraoperative setting during cardiac surgery. Therefore, the benefits of strain analysis have not yet been routinely utilized during the intraoperative course. However, new software solutions exist that can perform strain analysis fully automatically and reduce the examination time to a few seconds. However, it remains unclear whether these fully automated analyses also function reliably intraoperatively using transesophageal echocardiography (TEE). The aim of this study is to assess the reliability of these new methods.

Inclusion Criteria:

• Adult (≥18 years) cardiac surgery patients
• Sinus rhythm
• No severe valvular regurgitation
• Use of General Electric (GE) echocardiography systems (Vivid S60, S70, E95) and corresponding EchoPAC software as well as TOMTEC software.

Exclusion Criteria:

• Inadequate image quality
• Any severe heart valve regurgitation
• Mechanical circulatory support systems (e.g., LVAD, Impella, ECMO)

Patients undergoing cardiac surgery who are monitored with a transesophageal echocardiography probe