ACCURACY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PREOPERATIVE DETERMINATION OF AORTIC ANULUS SIZE DURING VALVE-REPLACEMENT

This prospective, blinded study evaluated the accuracy of transesophag eal (TEE) and transthoracic echocardiography in predicting the size of the surgical aortic valve anulus in 20 consecutive patients undergoin g aortic valve replacement. TEE was highly accurate in predicting surg ical aortic valve anulus size (p = 0.98; p < 0.00001). The standard er ror of the TEE estimate of the size of the obturator anulus was only 0 .04 mm, and in all cases the TEE estimate was within 1 mm of the direc t surgical measurement. Both biplane and multiplane TEE probes were eq ually accurate and this accuracy was maintained over a wide range of s izes of surgical aortic anulus. Transthoracic echocardiography appeare d less accurate in predicting anulus size (r = 0.64; p < 0.08). Theref ore TEE can be used routinely for selection and preparation of aortic allografts before sternotomy, potentially reducing cardiopulmonary byp ass pump time by 10 to 30 minutes and ensuring optimal size matching o f the donor-recipient anulus.