ELMSTREET (Esophageal Lesions during MitraClip uSing TRansEsophageal Echocardiography Trial)

We aimed to evaluate possible detrimental effects of transoesophageal echocardiography (TEE) on the oesophageal tissue during percutaneous mitral valve repair (PMVR).

From March 2014 to July 2015, 186 patients were treated for severe mitral regurgitation with PMVR using the MitraClip system. In 40 patients, oesophago-gastro-duodenoscopy was performed due to symptoms related to the gastrointestinal tract. Based on the procedure duration, patients were classified into group 1 (>60 minutes, n=23) or into group 2 (<60 minutes, n=17), respectively. Oesophageal lesions (OL) were found in 19 patients (group 1: n=17 vs. group 2: n=2, p<0.0001). We observed a change in leucocyte count after the procedure (group 1: +2.00 Gpt/L [SEM±0.48] vs. group 2: +0.54 Gpt/L [SEM±0.36], p=0.028). This change was more apparent when comparing patients with OL vs. those without (lesions: +2.65 Gpt/L [SEM±0.56] vs. no lesions: +0.23 Gpt/L [SEM±0.12], p<0.0001).

Prolonged use of TEE during PMVR with a procedure time of longer than 60 minutes increases the risk of oesophageal damage. An exceptional rise of leucocyte count after PMVR may raise suspicion of new oesophageal damage.