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. 2023 Apr;36(4):381-390.
doi: 10.1016/j.echo.2022.12.023. Epub 2023 Jan 5.

Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions

Ammar A Hasnie  1 , Vibhu Parcha  2 , Riem Hawi  2 , Michael Trump  2 , Naman S Shetty  2 , Mustafa I Ahmed  2 , Oscar J Booker  2 , Pankaj Arora  3 , Garima Arora  4
Affiliations

Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions

Ammar A Hasnie et al. J Am Soc Echocardiogr. 2023 Apr.

Abstract

Background: Transesophageal echocardiograms (TEEs) performed during transcatheter structural cardiac interventions may result in greater complications than those performed in the nonoperative setting or even those performed during cardiac surgery. However, there are limited data on complications associated with TEE during these procedures. We evaluated the prevalence of major complications among these patients in the United States.

Methods: A retrospective cohort study was conducted using an electronic health record database (TriNetX Research Network) from large academic medical centers across the United States for patients undergoing TEE during transcatheter structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography-endorsed International Statistical Classification of Diseases and Related Health Problems Clinical Modifications (10th edition) codes, patients undergoing TEE during a transcatheter structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, atrial septal defect closure, patent foramen ovale closure, and paravalvular leak repair, were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding and esophageal and upper respiratory tract injury). The secondary aim was the frequency of major complications, death, or cardiac arrest within 72 hours in patients who completed intraoperative TEE during surgical valve replacement.

Results: Among 12,043 adult patients (mean age, 74 years old; 42% female) undergoing TEE for transcatheter structural cardiac interventions, 429 (3.6%) patients had a major complication. Complication frequency was higher in patients on anticoagulation or antiplatelet therapy compared with those not on therapy (3.9% vs 0.5%; risk ratio [RR] = 8.09, P < .001). Compared with those patients <65 years of age, patients ≥65 years of age had a higher frequency of major complications (3.9% vs 2.2%; RR = 1.75, P < .001). Complication frequency was similar among male and female patients (3.5% vs 3.7%; RR = 0.96, P = .67). Among 28,848 patients who completed surgical valve replacement with TEE guidance, 728 (2.5%) experienced a major complication.

Conclusions: This study found that more than 3% of patients undergoing TEE during transcatheter structural cardiac interventions have a major complication, which is more common among those on anticoagulant or antiplatelet therapy or who are elderly. With a shift of poor surgical candidates to less invasive percutaneous procedures, the future of TEE-guided procedures relies on comprehensive risk discussion and updating practices beyond conventional methods to minimize risk for TEE-related complications.

Keywords: Outcomes; Transcatheter structural cardiac interventions; Transesophageal echocardiogram; Transesophageal echocardiogram related complications.

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Conflict of interest statement

Disclosures: None of the other authors had any conflicts of interest or financial disclosures to declare.

Figures

Figure 1:
Figure 1:. Derivation of the Study Population.
The TriNetX database was queried for applicable patients by using the American Society of Echocardiography-approved ICD-10 and CPT codes. After developing a study population from the database, they were further sub-stratified by age, sex, and prescribed medications. A separate cohort of patients who completed cardiac valve surgery with TEE guidance was also identified.
Figure 2:
Figure 2:. Comparing Frequency of Major Complications, Cardiac Arrest, and Death within 72 hours of Intervention between TEE used during transcatheter interventions and intraoperative TEE during cardiac valve surgeries.
The frequency of major complications, cardiac arrests, and death within 72 hours of a TEE-guided transcatheter intervention versus intraoperative TEE during cardiac valve surgery.
Figure 3:
Figure 3:. Temporal Trends of Major Complications, Cardiac Arrest, and Death Within 72 Hours of TEE-Guided Transcatheter Intervention
The frequency of major complications within 72 hours of a TEE-guided structural procedure between January 1st, 2012 to December 31st, 2016, and January 1st, 2017 to January 1st, 2022 is presented as a percentage.
See this image and copyright information in PMC

References

    1. Khandheria BK, Seward JB, Tajik AJ. Transesophageal echocardiography. Mayo Clin Proc. 1994;69(9):856–863. doi:10.1016/s0025-6196(12)61788-1 - DOI - PubMed
    1. Bailey SR, Weiner RB, Alagona P Jr, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011; 57:1126. - PubMed
    1. Peterson GE, Brickner ME, Reimold SC. Transesophageal echocardiography: clinical indications and applications. Circulation. 2003;107(19):2398–2402. doi:10.1161/01.CIR.0000071540.97144.89 - DOI - PubMed
    1. Perk G, Lang RM, Garcia-Fernandez MA, et al. “Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions”. J Am Soc Echocardiogr 2009;22:865–882. - PubMed
    1. Ender J, Sgouropoulou S. Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2013;2(6):796–802. doi:10.3978/j.issn.2225-319X.2013.10.09 - DOI - PMC - PubMed

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