• David Jeffrey Canty, Martin Kim, Ranjan Guha, Tuan Pham, Alistair G Royse, Sandy Errey-Clarke, Julian A Smith, and Colin F Royse.
• Department of Surgery, (Royal Melbourne Hospital), University of Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Victoria, Australia; Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Victoria, Australia. Electronic address: dcanty@unimelb.edu.au.
• J. Cardiothorac. Vasc. Anesth. 2020 Jan 1; 34 (1): 77-86.

ObjectivesTo compare agreement and variability of cardiac output measurement of 2-dimensional (2D) and 3D transesophageal echocardiography (TEE) with thermodilution before and after bypass.DesignProspective observational study.SettingTwo tertiary hospitals.InterventionsCardiac output (CO) was measured simultaneously with thermodilution and TEE by multiplying either the left ventricular outflow tract area (LVOTA) or aortic valve area (AVA), the velocity-time integral (VTI) of flow at the same site, and heart rate. The LVOTA was calculated using diameter for 2D TEE. Planimetry was used for 3D TEE. The AVA was measured using planimetry.ParticipantsThe study comprised 82 adult patients undergoing coronary or valve surgery.Measurements And Main ResultsOne hundred fifty-four complete sets of measurements were obtained (82 prebypass and 72 postbypass). All TEE methods had acceptable correlation and absence of proportional or fixed bias except for the left ventricular outflow tract (LVOT) VTI modal trace method, which had poor correlation and proportional but not fixed bias (regression coefficient [95% confidence interval], bias [percentage of mean CO]): 2D LVOT VTI modal trace 0.67 (0.54-0.80), -36.4%; 2D LVOT VTI outer edge trace 0.96 (0.80-1.12), -15.3%; 2D AVA planimetry 0.96 (0.75-1.18), +4.9%; 3D LVOT area planimetry 1.18 (0.96-1.41), +0.8%; 3D AVA planimetry 1.20 (0.93-1.46), +0.4%. All TEE methods had wide levels of agreement compared with thermodilution (-3.94 to +0.23 L/min, -2.83 to +1.28 L/min, -2.23 to +2.73 L/min, -2.35 to +2.42 L/min, and -2.57 to +2.61 L/min, respectively). Measurement variability was superior for all TEE methods compared with thermodilution before but not after bypass.ConclusionsAlthough limits of agreement of CO measurement with 3D TEE and thermodilution are wide, 2D planimetry of the AVA and continuous wave Doppler may be substituted for thermodilution before and after bypass.Copyright © 2019 Elsevier Inc. All rights reserved.

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