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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Transesophageal echocardiography complications associated with interventional cardiology procedures
Afonso B Freitas-Ferraz1, Josep Rodés-Cabau1, Lucía Junquera Vega1
1Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
Insights
Transesophageal echocardiography (TEE) guidance during interventional procedures has a higher complication rate than previously thought. Prolonged procedural time, especially during Mitraclip, significantly increases the risk of TEE-related complications.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Transesophageal echocardiography (TEE) is crucial for guiding cardiac interventions.
- Existing data on TEE-related complications primarily focuses on post-cardiac surgery manipulation.
- Limited information exists regarding TEE safety during catheter-based interventions.
Purpose of the Study:
- To determine the prevalence, types, and risk factors of complications associated with active TEE guidance in interventional procedures.
- To compare complication rates between different types of catheter-based interventions based on TEE manipulation intensity.
Main Methods:
- A retrospective analysis of 1249 patients undergoing TAVI, Mitraclip, LAAO, or PVLC.
- Patients were stratified into low-risk (TAVI) and high-risk (Mitraclip, LAAO, PVLC) cohorts based on TEE manipulation.
- Analysis of major and minor TEE-related complications and associated risk factors.
Main Results:
- Overall TEE complication rates were 0.9% for TAVI and 6.1% for other procedures (P < .001).
- High-risk cohort showed increased major complications (2.8% vs 0.6%, P = .008).
- Risk factors included being underweight, prior GI bleeding, chronic steroid use, and longer procedural time under TEE (OR=1.13 per 10 min).
Conclusions:
- TEE-related complications in interventional procedures are more prevalent than previously reported.
- Prolonged procedural duration, particularly during Mitraclip procedures, is a key predictor of complications.
- Identifying and mitigating risk factors is crucial for improving TEE safety in interventions.
Background:
Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance.
Methods:
This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Patients were divided into 2 cohorts based on the degree of probe manipulation required to guide the procedure and the risk of developing a TEE-related complication: low-risk (TAVI, n = 1037) and high-risk (Mitraclip, LAAO and PVLC, n = 212). Patients were further analyzed according to the occurrence of major and minor TEE-related complications.
Results:
The overall incidence of TEE-related complications was 0.9% in the TAVI group and 6.1% in the rest of the cohort (P < .001). Patients in the high-risk cohort had also a higher incidence of major-complications (2.8% vs 0.6%, P = .008), and factors associated with an increased risk were being underweight, having a prior history of gastrointestinal bleeding and the use of chronic steroids/immunosuppressive medications. Procedural time under TEE-manipulation was longer in patients exhibiting complications and was an independent predictor of major complications (OR = 1.13, 95% CI 1.01-1.25, for each 10 minutes increments in imaging time). Patients with major complications undergoing Mitraclip had the longest median time under TEE-manipulation (297 minutes) and a risk of developing a major-complication that was 10.64 times higher than the rest of the cohort (95% CI 3.30-34.29, P < .001).
Conclusion:
The prevalence of TEE-related complications associated with interventional procedures is higher than previously reported. Undergoing a prolonged procedure, particularly in the setting of Mitraclip, was the main factor linked to TEE-related complications.
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