The safety of transesophageal echocardiography in the elderly

The safety of transesophageal echocardiography (TEE) in elderly patients (aged > or = 70 years) and young patients (aged < or = 50 years) was compared in a retrospective study of 283 examinations in each group. A greater percentage of studies was performed in an intensive care unit in the elderly group (22%) as compared with the younger group (13%, p < 0.02). In studies performed in an intensive care unit, 39% (24/61) of patients in the elderly group and 45% (17/38) in the young group were on ventilators. Transient systemic hypotension complicating TEE was 3.5 times more frequent in the elderly (5%) as compared with the young group (1.4%, p < 0.02). Life-threatening complications associated with TEE were rare (< 0.01%) and included third-degree atrioventricular block in one patient and profound vasovagal reaction in one patient in the elderly group and myocardial ischemia in one patient in the young group. Being elderly and on a ventilator were independent predictors of the development of systemic hypotension during TEE. Overall, TEE is a low-risk procedure but is associated with a 3.5 times greater risk of systemic hypotension in elderly patients as compared with younger subjects. The benefit and risk should be assessed in all patients before TEE, particularly in the elderly.