Gastrointestinal Complications After Transesophageal Echocardiography for Mitral Valve Transcatheter Edge-to-Edge Repair: Insights From a Large Contemporary Cohort

Nika Samadzadeh Tabrizi; Isha Doshi; Alexander D Shapeton; Perry A Stout; Stephanie B Jones; Mohammad El-Hajjar; Mikhail Torosoff; Sridhar R Musuku

doi:10.1053/j.jvca.2023.06.003

Gastrointestinal Complications After Transesophageal Echocardiography for Mitral Valve Transcatheter Edge-to-Edge Repair: Insights From a Large Contemporary Cohort

J Cardiothorac Vasc Anesth. 2023 Oct;37(10):1922-1928. doi: 10.1053/j.jvca.2023.06.003. Epub 2023 Jun 5.

Authors

Nika Samadzadeh Tabrizi¹, Isha Doshi², Alexander D Shapeton³, Perry A Stout², Stephanie B Jones⁴, Mohammad El-Hajjar⁵, Mikhail Torosoff⁶, Sridhar R Musuku⁴

Affiliations

¹ Albany Medical College, Albany, NY. Electronic address: samadzn@amc.edu.
² Albany Medical College, Albany, NY.
³ Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA.
⁴ Department of Anesthesia, Albany Medical Center, Albany, NY.
⁵ Department of Interventional Cardiology, Albany Medical Center, Albany, NY.
⁶ Department of Cardiology, Albany Medical Center, Albany, NY.

PMID: 37385884
DOI: 10.1053/j.jvca.2023.06.003

Abstract

Objectives: Transesophageal echocardiography-related complications (TEE-RC) are higher in structural heart interventions than in traditional operative settings. In mitral valve transcatheter edge-to-edge repair (MV-TEER), the incidence of TEE-RC may be higher than in other structural interventions. However, existing reports are limited and robust data evaluating TEE safety in this patient population are lacking. The authors sought to describe the incidence and risk factors of upper gastrointestinal injuries after TEE in patients undergoing MV-TEER.

Design: A retrospective observational study.

Setting: A single tertiary academic hospital.

Participants: A total of 442 consecutive patients who underwent MV-TEER, specifically with MitraClip, between December 2015 and March 2022.

Interventions: Transesophageal echocardiography was performed intraoperatively to guide all MV-TEERs.

Measurements and main results: The study's primary goal was to investigate an association between TEE procedure duration and TEE-RC risk. The contribution of demographic risk factors and intraprocedural characteristics also was investigated. Transesophageal echocardiography-RCs were observed in 17 out of 442 patients (3.8%). Dysphagia was the most common TEE-RC (n = 9/17, 53%), followed by new gastroesophageal reflux (n = 6/17, 35%) and odynophagia (n = 3/17, 18%). There were no esophageal perforations or upper gastrointestinal bleeds. History of dysphagia was the only variable associated with TEE-RCs (p = 0.008; n = 9 [2.1%] v n = 3 [18%]), with a relative risk of 8.67 (95% CI 2.57, 29.16). The TEE procedure duration was not statistically different between the 2 groups (46 minutes [39-64] in TEE-RCs v 49 minutes [36-77] in no complications).

Conclusion: In patients undergoing MV-TEER, TEE-RCs are uncommon, and major complications are rare. The authors' outcomes reflect those of a high-volume referral center with TEEs performed by cardiac anesthesiologists.

Keywords: MitraClip; transcatheter-edge-to-edge repair; transesophageal echocardiography; upper gastrointestinal injury.

Publication types

Observational Study

MeSH terms

Cardiac Surgical Procedures* / methods
Deglutition Disorders*
Echocardiography, Transesophageal / adverse effects
Echocardiography, Transesophageal / methods
Humans
Mitral Valve / diagnostic imaging
Mitral Valve / surgery
Mitral Valve Insufficiency* / diagnostic imaging
Mitral Valve Insufficiency* / surgery