The feasibility of tricuspid annular plane systolic excursion performed by transesophageal echocardiography throughout heart surgery and its interchangeability with transthoracic echocardiography

Abstract

Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in > 90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.

Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study

“…30,31 A strength in the current study was that we applied TEE views and assessment of TAPSE on the basis of observations from a previous investigation. 13 In that study we found that anatomic M-mode in the transgastric view showed the best performance compared with TTE throughout surgery. Flo Forner and colleagues 30 have also shown good agreement between TTE and TEE anatomic M-mode TAPSE, but only in the preoperative setting-not throughout surgery.…”

“…This technique has been previously validated. 13 An experienced cardiac anesthesiologist (A.K. ), with extensive echocardiographic experience and To assess other contractile indices of RV function we also analyzed tissue Doppler velocity measurements of the lateral tricuspid annulus and pulmonary artery (PA) velocity time at all 5 stages of surgery in all patients.…”

“…These echocardiographic techniques have also been previously validates. 13 All measurements were read off-line as the average of 2 repeated acquisitions. Mean arterial pressures, central venous pressures, and heart rates were recorded at all time points.…”

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

“…Therefore, alternative and less angle-dependent techniques seem more promising. Measurement of TAPSE by anatomic M-mode which evaluates two-dimensional pixel samples along a freely positioned cursor line presented increased precision [26,28]. A further approach is to measure TAPSE with speckle-tracking echocardiography, which is mainly angle-independent [28,29].…”

“…Measurement of TAPSE by anatomic M-mode which evaluates two-dimensional pixel samples along a freely positioned cursor line presented increased precision [26,28]. A further approach is to measure TAPSE with speckle-tracking echocardiography, which is mainly angle-independent [28,29]. First investigations showed promising and unbiased results; however, there seems to be doubt about precision and reliability [29,30].…”