Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study

Purza, Razvan; Ghosh, Subhamay; Walker, Chris; Hiebert, Brett; Koley, Lillian; Mackenzie, G. Scott; Grocott, Hilary P.

doi:10.1016/j.athoracsur.2016.06.073

Cited by 71 publications

(38 citation statements)

References 18 publications

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“…found a major gastro‐intestinal complication and mortality rate of 0.09% and 0.02%, respectively, although a number of assumptions and extrapolations were used to derive these figures . More recently, a retrospective study of ~8000 patients from Canada reported a much higher complication rate of 1.4%, although included complications were mostly minor . Although 23 patients with TOE‐related complications died, causes of death in these patients were not attributed to TOE probe use.…”

Section: Discussionmentioning

confidence: 99%

Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

et al. 2019

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Summary Previous studies on the safety of peri‐operative transoesophageal echocardiography seem to suggest a low rate of associated morbidity and mortality. That said, there has been a paucity of prospective multicentre studies in this important area of clinical practice. We carried out a one‐year prospective study in 2017, co‐ordinated by the Association of Cardiothoracic Anaesthesia and Critical Care, to determine the rate and severity of complications associated with peri‐operative transoesophageal echocardiography in anaesthetised cardiology and cardiac surgical patients. With the help of clinicians from 28 centres across the UK and Ireland, we recorded the total number of examinations conducted in anaesthetised patients during the study period. All major complications at each centre were prospectively reported and recorded. Of the 22,314 examinations, there were 17 patients diagnosed with a major complication which caused either palatal injury or gastro‐oesophageal disruption. This corresponds to an incidence of 0.08% (95%CI 0.05–0.13%) or approximately 1:1300 examinations. There were seven deaths reported during the study period which were directly attributed to these complications, corresponding to an incidence of 0.03% (95%CI 0.01–0.07%) or approximately 1:3000. These figures are higher than previously reported and suggest a high probability of death following the development of a complication (~40%). Most complications occurred in patients without known risk factors for transoesophageal echocardiography associated gastro‐oesophageal injury. We suggest clinicians and departments review their procedural guidelines, especially in relation to probe insertion techniques, together with the information communicated to patients when the risks and benefits of such examinations are discussed.

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Section: Discussionmentioning

confidence: 99%

Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

et al. 2019

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“…1 Compression of the esophagus by vertebral osteophytes is currently not a contraindication to TEE according to practice guidelines. 2 We present the case of an elderly patient who developed an esophageal perforation after TEE secondary to prominent thoracic vertebral osteophytes compressing the esophagus during a transcatheter aortic valve replacement (TAVR) procedure. We suggest that significant anterior vertebral osteophytes that compress the esophagus, particularly in elderly patients under general anesthesia, should be considered a relative contraindication to TEE.…”

Section: Introductionmentioning

confidence: 99%

Esophageal Perforation with Transesophageal Echocardiography in an Elderly Patient with Prominent Vertebral Osteophytes: A Case Report and a Review of the Literature

Royer¹,

Couture²,

Nicodème³

et al. 2020

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“…Intraoperative transesophageal echocardiography (TEE) provides valuable information during cardiac surgery but can be associated with mucosal injuries resulting in ulceration, necrosis, and perforation. 1 We present images of a patient who sustained esophageal ulcerations from a TEE probe during coronary artery bypass graft (CABG) surgery. After 7 days, a repeat endoscopy showed significant resolution of the ulceration and inflammation.…”

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confidence: 99%

Transesophageal echocardiography induced esophageal ulceration

Gudivada

Umesh

2018

J Card Surg

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Intraoperative transesophageal echocardiography (TEE) provides valuable information during cardiac surgery but can be associated with mucosal injuries resulting in ulceration, necrosis, and perforation. 1 We present images of a patient who sustained esophageal ulcerations from a TEE probe during coronary artery bypass graft (CABG) surgery. A 69-year-old hypertensive, diabetic female, with no history of esophageal or gastric disease, underwent a CABGx3 with a left internal mammary artery graft to the left anterior descending artery, and saphenous vein grafts (SVG) to the right coronary artery (RCA) and an obtuse marginal branch during a cardiopulmonary bypass (CPB) time of 165 min. A TEE probe had been atraumatically inserted and left in place in the thoracic esophagus and kept in the neutral, unlocked position when imaging was not performed. Three hours following the CABG, she developed ST segment elevation in the inferior leads and was taken back to the operating room where the TEE probe was reinserted and a thrombosed SVG graft to the RCA was replaced during a CPB time of 75 min. The patient developed postoperative low cardiac output syndrome (LCOS) and required 45 h of inotropic support. On the second postoperative day, she developed a fever, became hypoxic, and complained of retrosternal pain. Esophagogastroscopy revealed a deep ulcer in the posterior wall of the mid thoracic esophagus with anterior wall erosion consistent with a TEE-induced ulceration (Figure 1). The patient was kept NPO and received 7 days of total parental nutrition and 14 days of IV meropenem, vancomycin, fluconazole, and pantoprazole.After 7 days, a repeat endoscopy showed significant resolution of the ulceration and inflammation. Enteral nutrition was initiated and she was discharged home on the 16th postoperative day on pantoprazole 40 mg po QD along with her cardiac medications.We suspect that the prolonged period of CPB and protracted TEE probe contact time combined with the extended period of LCOS contributed to the increased risk for TEE induced esophageal ulceration in this patient.

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Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study

Abstract: The overall incidence of TEE complications after cardiac surgery was 1.4%. Advanced age, low body mass index, complexity of procedure, prior stroke, prolonged bypass time, and return to the operating room appear to be significant risk factors for TEE complications.

Cited by 71 publications

References 18 publications

Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

Esophageal Perforation with Transesophageal Echocardiography in an Elderly Patient with Prominent Vertebral Osteophytes: A Case Report and a Review of the Literature

Transesophageal echocardiography induced esophageal ulceration

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