ABSTRACT
Transesophageal echocardiography (TEE) has become an indispensable part of cardiothoracic surgery at present and is considered to be a safe procedure, rarely associated with complications. However, TEE may cause serious and life threatening complications, as presented in this case report. We describe a patient who developed an empyema after elective cardiac surgery due to an esophageal perforation caused by TEE, without any clinical symptoms. Risk factors for TEE-related complications, identified in recent literature, will be discussed as well as the remarkable absence of clinical symptoms in this particular patient.
Subject(s)
Cardiac Surgical Procedures , Esophageal Perforation , Humans , Esophageal Perforation/diagnostic imaging , Esophageal Perforation/etiology , Cardiac Surgical Procedures/adverse effects , Echocardiography, Transesophageal , Risk Factors , Elective Surgical Procedures/adverse effectsABSTRACT
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI. METHODS: We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes. RESULTS: We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5⯱ 4.0 vs pre-COVID 4.6⯱ 4.2, pâ¯= 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, pâ¯< 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, pâ¯= 0.134), major vascular complications (2.3% vs 3.4%, pâ¯= 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, pâ¯= 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, pâ¯= 0.359 and 5.2% vs 5.2%, pâ¯= 0.993, respectively). CONCLUSIONS: During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality.
