Background:
Transesophageal echocardiography (TEE) is essential for transcatheter edge-to-edge repair (TEER) procedures and often requires prolonged probe manipulation under general anesthesia. Although gastroesophageal (GE) lesions may occur after TEE-guided procedures, predictors of relevant injuries requiring endoscopic treatment remain unclear.
Purpose:
The aim of our study is to evaluate prolonged intervention time as an independent predictor of TEE-related silent GE lesions in patients undergoing M-TEER and T-TEER and to identify strategies for their prevention and management.
Methods:
A total of 180 patients undergoing TEER at our institution were retrospectively evaluated, including 90 T-TEER and 90 M-TEER patients. All patients underwent esophagogastroduodenoscopy (EGD) on the first post-procedural day regardless of symptoms. Gastroesophageal lesions were classified according to the Forrest classification for upper gastrointestinal bleeding. Procedures were performed under general anesthesia following a standardized protocol. Multivariable analysis was performed to identify independent predictors of GE lesions requiring endoscopic hemoclip therapy.
Results:
Baseline characteristics were comparable between groups, except for a higher prevalence of atrial fibrillation and lower prevalence of pacemaker leads in the T-TEER group. Procedure duration was significantly longer in T-TEER compared with M-TEER patients (97.6±5.1 vs. 79.6±3.3 minutes, p=0.004). Post-TEER EGD revealed 37 (33.3%) GE lesions in the T-TEER group and 27 (24.3%) GE lesions in the M-TEER group classified as following: Forrest Ia 0 (0%) in both groups, Forrest Ib 3 (3.3%) vs 2 (2.2 %), Forrest IIa 2 (2.2%) vs 2 (2.2%), Forrest IIb 19 (21.1%) vs 10 (11.1%), Forrest IIc 6 (6.7%) vs 4 (4.4%) and Forrest III 7 (7.8%) vs 9 (10%). The remaining patients had no lesions or minimal lesions or hematoma that could not be classified according to the Forrest classification. 21/180 patients (11.7%) required endoscopic hemostatic intervention. Endoscopic hemoclip therapy was required in 13 T-TEER patients (14.4%) and 8 M-TEER patients (8.9%) (p=0.246, not significant).
Patients who needed endoscopic treatment had significantly longer procedure times than those without endoscopic treatment (108.0±10.4 vs. 86.1±3.2 minutes, p=0.023). A multivariable analysis including procedure type (M-TEER und T-TEER), age, sex, diabetes mellitus and renal function revealed the procedure time as an independent predictor for GE lesions requiring endoscopic treatment (p=0.031). ROC analysis identified a cut-off value of 91.5 minutes as increased risk for GE lesions requiring endoscoic treatment.
Conclusion:
Major injury and GE-bleeding requiring endoscopic treatment post-TEER are rare but may occur even in asymptomatic patients. Procedure duration time with a cut-off value of more than 91,6 minutes represents an independent predictor of silent TEE-related injury, needing endoscopic treatment. Therefore we would recommend a routine EGD even in asymptomatic patients after procedure times longer than 91,5 minutes.
