Comparison of Preoperative and Intraoperative Assessment of Tricuspid Valve Annular Diameter and Tricuspid Regurgitation Grade by Echocardiography in Patients Undergoing Mitral Valve Surgery.

内容摘要

To compare preoperative transthoracic echocardiography (TTE) and intraoperative transesophageal echocardiography (TEE) assessment of (1) tricuspid annular diameter (TAd) and (2) tricuspid regurgitation (TR) grade in adults undergoing mitral valve surgery, with or without concomitant tricuspid surgery. Retrospective cohort study. Single tertiary academic medical center. Seventy-seven consecutive adults presenting for mitral valve surgery with an available preoperative TTE performed ≤1 week before surgery. None. Multiple TAd measurements were made with the maximum diastolic TAd recorded per modality (TTE: apical 4-chamber; TEE: mid-esophageal 4-chamber). TR severity was graded per society guidelines. Paired comparisons, correlation, and Bland-Altman analyses were performed. Mean preoperative TTE TAd was 38.0 ± 4.9 mm (TTE) versus mean intraoperative TEE TAd of 37.2 ± 5.4 mm (TEE), with a mean paired difference of +0.83 ± 5.04 mm (95% CI, -0.31 to 1.98; p = 0.152). TEE TAd measurement was decreased compared with TTE in 44 of 77 (57.1%) patients, increased in 27 of 77 (35.1%), and was unchanged in 6 of 77 (7.8%) (p = 0.009 for decreased > increased). TR grade distributions also differed between modalities (p = 0.008), with TEE TR severity increased compared with TTE in 22 of 77 (28.6%), decreased in 15 of 77 (19.5%), and unchanged in 40 of 77 (51.9%). TAd correlation was moderate (Pearson r = 0.526; Spearman ρ = 0.521). Bland-Altman analysis demonstrated a small bias (+0.83 mm) but wide limits of agreement (-9.05 to +10.71 mm), indicating substantial case-level variability. Although TTE and TEE yield similar mean TAd, per-patient agreement is only moderate. In addition, TR grade is frequently reclassified under anesthesia. Reliance on intraoperative TEE for either TAd or TR severity assessment may lead to misclassification, particularly in borderline cases. Relying chiefly on TTE assessment, considering hemodynamic context, and incorporating TEE 3-dimensional annular metrics when available may improve decision-making regarding concomitant tricuspid repair during mitral surgery.