Operative Research Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
Echocardiography. 2024 Jun;41(6):e15861. doi: 10.1111/echo.15861.
Transesophageal echocardiography (TEE) is primarily used to guide transcatheter structural heart interventions, such as tricuspid transcatheter edge-to-edge repair (TEER). Although TEE has a good safety profile, it is still an invasive imaging technique that may be associated with complications, especially when performed during long transcatheter procedures or on frail patients. The aim of this study was to assess TEE-related complications during tricuspid TEER.
This is a prospective study enrolling 53 patients who underwent tricuspid TEER for severe tricuspid regurgitation (TR). TEE-related complications were assessed clinically and divided into major (life-threatening, major bleeding requiring transfusions or surgery, organ perforation, and persistent dysphagia) and minor (perioral hypesthesia, < 24 h dysphagia/odynophagia, minor intraoral bleeding and hematemesis not requiring transfusion) RESULTS: The median age of the patient population was 79 years; 43.4% had severe, 39.6% massive, and 17.6% torrential TR. 62.3% of patients suffered from upper gastrointestinal disorders. Acute procedural success (APS) was achieved in 88.7% in a median device time of 36 min. A negative association was shown between APS and lead-induced etiology (r = -.284, p = .040), baseline TR grade (r = -.410, p = .002), suboptimal TEE view (r = -.349, p = .012), device time (r = -.234, p = .043), and leaflet detachment (r = -.496, p < .0001). We did not observe any clinical manifest major or minor TEE-related complications during the hospitalization.
Our study reinforces the good safety profile and efficacy of TEE guidance during tricuspid TEER. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious complications. Furthermore, suboptimal intraprocedural TEE views are associated with lower TR reduction rates.
Transesophageal echocardiography is a crucial and safe technique for guiding transcatheter structural heart interventions. A mix of mid/deep esophageal and trans gastric views, as well as real-time 3D imaging is generally used to guide the procedure. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious problems. A shorter device time is associated with more rarely probe-related complications. Suboptimal intraprocedural TEE views are associated with lower TR reduction rates.
经食管超声心动图（TEE）主要用于指导经导管结构性心脏介入治疗，如三尖瓣经导管缘对缘修复术（TEER）。尽管 TEE 具有良好的安全性，但它仍然是一种有创的影像学技术，可能会引起并发症，尤其是在进行长时间的经导管手术或对体弱患者进行操作时。本研究旨在评估三尖瓣 TEER 期间与 TEE 相关的并发症。
这是一项前瞻性研究，共纳入 53 例因严重三尖瓣反流（TR）而行三尖瓣 TEER 的患者。临床评估 TEE 相关并发症，并分为主要并发症（危及生命、需要输血或手术的大量出血、器官穿孔和持续性吞咽困难）和次要并发症（口周感觉减退、<24 小时吞咽困难/疼痛、轻微口腔内出血和无需输血的呕血）。
患者的中位年龄为 79 岁；43.4%为严重反流，39.6%为大量反流，17.6%为 torrential 反流。62.3%的患者患有上消化道疾病。中位设备使用时间为 36 分钟时，急性手术成功率（APS）达到 88.7%。APS 与导丝诱导病因（r=-.284，p=0.040）、基线 TR 分级（r=-.410，p=0.002）、TEE 视图不佳（r=-.349，p=0.012）、设备使用时间（r=-.234，p=0.043）和瓣叶分离（r=-.496，p<0.0001）呈负相关。我们在住院期间未观察到任何明显的与 TEE 相关的严重或轻微并发症。
本研究进一步证实了 TEE 指导三尖瓣 TEER 的良好安全性和有效性。为避免严重并发症，术前管理和术中预防措施是必要的。此外，术中 TEE 视图不佳与较低的 TR 降低率相关。
经食管超声心动图是指导经导管结构性心脏介入治疗的关键和安全技术。通常使用中/深食管和经胃视图以及实时 3D 成像来指导手术。为避免严重问题，术前管理和术中预防措施是必要的。设备使用时间越短，与探头相关的并发症发生越不频繁。术中 TEE 视图不佳与较低的 TR 降低率相关。
