Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC.
University of Rochester School of Medicine and Dentistry, Rochester, NY.
J Cardiothorac Vasc Anesth. 2019 Sep;33(9):2376-2384. doi: 10.1053/j.jvca.2019.03.046. Epub 2019 Mar 30.
The authors hypothesized that grading valvular aortic stenosis (AS) with dimensionless index (DI) during intraoperative pre-cardiopulmonary bypass (pre-CPB) transesophageal echocardiography (TEE) would match the grade of AS during preoperative transthoracic echocardiography (TTE) for the same patients more often than when using peak velocity (V), mean pressure gradient (PG), or aortic valve area (AVA).
Retrospective, observational.
Single university hospital.
The participants in this study included 123 cardiac surgical patients with any degree of AS, who underwent open cardiac surgery between 2010 and 2016 at the Medical University of South Carolina and had V, PG, AVA, and DI values available from reporting databases or archived imaging.
None.
When using DI, pre-CPB TEE grading of AS severity was 1 grade higher 21.1% of the time and 1 grade lower 13.0% of the time compared with TTE, for an overall disagreement rate of 34.1%. The overall disagreement rates between pre-CPB TEE and TTE for V, PG, and AVA were 39.8%, 33.3%, and 33.3%, respectively.
The authors could not demonstrate that DI was better than V, PG, or AVA at matching AS grades between intraoperative pre-CPB TEE and preoperative TTE. When DI was used, pre-CPB TEE was more likely to overestimate than underestimate the severity of AS compared with TTE. However, when V or PG was used, pre-CPB TEE was more likely to underestimate the severity of AS compared with TTE. A comprehensive approach without overemphasis on 1 parameter should be used for AS assessment by intraoperative TEE.
作者假设在体外循环（CPB）前经食管超声心动图（TEE）术中用无量纲指数（DI）对主动脉瓣狭窄（AS）进行分级，与同一患者术前经胸超声心动图（TTE）时的 AS 分级更匹配，而不是使用峰值速度（V）、平均压力梯度（PG）或主动脉瓣面积（AVA）。
回顾性，观察性。
单一大学医院。
这项研究的参与者包括 123 名患有任何程度 AS 的心脏外科患者，他们于 2010 年至 2016 年期间在南卡罗来纳医科大学接受了开放性心脏手术，并从报告数据库或存档的图像中获得了 V、PG、AVA 和 DI 值。
无。
使用 DI 时，与 TTE 相比，CPB 前 TEE 对 AS 严重程度的分级有 21.1%的时间高 1 级，有 13.0%的时间低 1 级，总不一致率为 34.1%。CPB 前 TEE 与 TTE 对 V、PG 和 AVA 的总体不一致率分别为 39.8%、33.3%和 33.3%。
作者无法证明 DI 在匹配术中 CPB 前 TEE 和术前 TTE 的 AS 分级方面优于 V、PG 或 AVA。与 TTE 相比，当使用 DI 时，CPB 前 TEE 更有可能高估而不是低估 AS 的严重程度。然而，当使用 V 或 PG 时，CPB 前 TEE 更有可能低估 AS 的严重程度。在评估术中 TEE 时，应采用无过分强调某一参数的综合方法。
