Author + information
- Received March 17, 2020
- Revision received April 9, 2020
- Accepted April 23, 2020
- Published online June 22, 2020.
- Afonso B. Freitas-Ferraz, MDa,
- Mathieu Bernier, MDa,∗∗ (, )
- Rosaire Vaillancourt, MDb,
- Paula A. Ugalde, MDb,
- Frédéric Nicodème, MD, PhDb,
- Jean-Michel Paradis, MDa,
- Jean Champagne, MDa,
- Gilles O’Hara, MDa,
- Lucia Junquera, MDa,
- David del Val, MDa,
- Guillem Muntané-Carol, MDa,
- Kim O’Connor, MDa,
- Jonathan Beaudoin, MDa and
- Josep Rodés-Cabau, MDa,∗ (, )@IUCPQ
- aDepartment of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- bDepartment of Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
Background Despite the widespread use of transesophageal echocardiography (TEE) to guide structural cardiac interventions, studies evaluating safety in this context are lacking.
Objectives This study sought to determine the incidence, types of complications, and factors associated with esophageal or gastric lesions following TEE manipulation during structural cardiac interventions.
Methods This was a prospective study including 50 patients undergoing structural cardiac interventions in which TEE played a central role in guiding the procedure (mitral and tricuspid valve repair, left atrial appendage closure, and paravalvular leak closure). An esophagogastroduodenoscopy (EGD) was performed before and immediately after the procedure to look for new injuries that might have arisen during the course of the intervention. Patients were divided in 2 cohorts according to the type of injury: complex lesions (intramural hematoma, mucosal laceration) and minor lesions (petechiae, ecchymosis). The factors associated with an increased risk of complications were assessed.
Results Post-procedural EGD showed a new injury in 86% (n = 43 of 50) of patients, with complex lesions accounting for 40% (n = 20 of 50) of cases. Patients with complex lesions presented more frequently with an abnormal baseline EGD (70% vs. 37%; p = 0.04) and had a higher incidence of post-procedural dysphagia or odynophagia (40% vs. 10%; p = 0.02). Independent factors associated with an increased risk of complex lesions were a longer procedural time under TEE manipulation (for each 10-min increment in imaging time, odds ratio: 1.27; 95% confidence interval: 1.01 to 1.59) and poor or suboptimal image quality (odds ratio: 4.93; 95% confidence interval: 1.10 to 22.02).
Conclusions Most patients undergoing structural cardiac interventions showed some form of injury associated with TEE, with longer procedural time and poor or suboptimal image quality determining an increased risk. Imaging experts performing this technique should be aware of the nature of potential complications, to take the necessary precautions to prevent their occurrence and facilitate early diagnosis and treatment.
- edge-to-edge repair
- esophageal lesions
- left atrial appendage closure
- transesophageal echocardiography
Dr. Freitas-Ferraz was supported by a research grant from the Quebec Heart & Lung Institute Fondation. Drs. Junquera, del Val, and Muntané-Carol are supported by a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Jayashri Aragam, MD, served as Guest Associate Editor for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 17, 2020.
- Revision received April 9, 2020.
- Accepted April 23, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.