Intervention time represents an independent predictor for esophageal lesions during M-TEER and T-TEER procedures

Background

Transesophageal echocardiography (TEE) is essential in M-TEER and T-TEER interventions which often require extensive probe manipulations and long intervention times, which may increase the risk of gastroesophageal (GE) injury. Nevertheless, data on TEE-related GE complications, remain limited.

Purpose

The aim of our study was to evaluate the influence of prolonged intervention time on TEE-related silent GE lesions in pts undergoing M-TEER and T-TEER

Methods

A total of 180 pts underwent TEER at our institution, including 90 T-TEER pts and 90 M-TEER pts. All pts underwent esophagogastroduodenoscopy (EGD) on the first post-procedural day. Complications were classified according to the Forrest classification for upper gastrointestinal bleeding. All procedures were performed under general anesthesia following a standardized protocol by the same interventional team.

Results

Baseline characteristics besides atrial fibrillation (TC 92.2% vs MC 77.8%; p=0.01) were comparable between the groups. No significant differences were found in age (TC 80.5±0.5 vs MC 80.02±9.6), body mass index (BMI) (TC 26.5±0.5 vs MC 26.9±0.7), EuroSCORE I (TC 22.5±1.2 vs MC 24.3±1.2), renal function Crea (TC 121.5±7.9 vs MC 120.3±6.1), BNP levels (TC 707.2±127.5 vs MC 720±104.9), or comorbidities including CAD (64% vs 70.8%), HLP (TC 52.2% vs MC 56%) , HTN (TC 72.2% vs MC 86.7%), DM (TC 31.1% vs 31.1).

Procedure duration was significantly longer in the T-TEER (97.6 ± 5.1 minutes) compared with the M-TEER group (79.6 ± 3.3 minutes); p = 0.004. There were significantly more clips implanted in the T-TEER group (TC 1.99 ±0.09 vs MC 1.49±0.07, p=<0.01)

EGD revealed GE lesions, categorized according to the Forrest classification, in 37 pts (41.1%) in the T-TEER and 27 pts (30.0%) in the M-TEER group. Small hematomas or superficial lacerations were observed in 21 T-TEER pts (23.3%) and 26 M-TEER pts (28.9%).

Endoscopic intervention using hemoclips to treat or prevent further bleeding was required in 13 T-TEER pts (14.4%) and 8 M-TEER pts (8.9%), p = 0.246. Patients requiring endoscopic therapy had significantly longer procedure times (108.0±10.4 minutes) compared with those who did not require intervention (86.1±3.2 minutes); p = 0.023.

A multivariate regression analysis including the kind of intervention (T-TEER/M-TEER), age, sex, DM, renal insufficiency, only prolonged intervention time revealed to be an independent predictor for GE lesions that have to be treated by hemoclips (p =0,031).

ROC analysis identified a cut-off value of intervention time of 91.5 minutes.

Conclusion

Prolonged Intervention time during TEER procedures represents an independent predictor of GE lesions requiring endoscopic treatment and routine EGD should be considered in those pts with intervention times longer than 91.5 minutes.