Transesophageal echocardiography complications associated with interventional cardiology procedures.
Am Heart J
; 221: 19-28, 2020 03.
Article
em En
| MEDLINE
| ID: mdl-31896037
ABSTRACT
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, nâ¯=â¯1037) and high-risk (Mitraclip, LAAO and PVLC, nâ¯=â¯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 (Pâ¯<â¯.001). Patients in the high-risk cohort had also a higher incidence of major-complications (2.8% vs 0.6%, Pâ¯=â¯.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 (ORâ¯=â¯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, Pâ¯<â¯.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.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Cateterismo Cardíaco
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Transtornos de Deglutição
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Ecocardiografia Transesofagiana
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Esôfago
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Substituição da Valva Aórtica Transcateter
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Hemorragia Gastrointestinal
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Revista:
Am Heart J
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Canadá