Background:
TEER is a minimally invasive procedure for patients (pts) with severe mitral or tricuspid regurgitation and high surgical risk. Transoesophageal echocardiography (TEE) is crucial to guide this complex intervention. As most of the pts have an indication for anticoagulation and are discharged home early, it is important to rule out significant lesions in the oesophagus associated to the TEE probe.
Purpose:
This study aims to investigate the impact of prolonged intervention time on the incidence, type and severity of TEE-related silent GE lesions in pts undergoing M-TEER and T-TEER.
Methods:
We analysed a total of 167 pts who underwent TEER at our institution: 79 underwent T-TEER and 88 underwent M-TEER. On the first postintervention day EGD was performed in all patients. All relevant lesions were categorized according to the Forrest classification for upper GI bleeding.
Results:
There was no significant difference in the T-TEER and M-TEER group concerning age, BMI, EuroScore I/II, kidney function, BNP levels or other comorbidities (coronary artery disease, hypertension, hyperlipidaemia, diabetes) except for atrial fibrillation (74 pts (93.7%) in the T-TEER group and 60 pts (78.4%) in the M-TEER group , p= 0.007) and the presence of pace maker (10 pts (12.7%) in the T-TEER and 24 pts (27.3%) in the M-TEER, p=0.022)
Procedure duration was significantly longer for T-TEER (100.7± 5.6 min) compared to M-TEER (79.8 ± 3.4 min), p=0.001.
EGD identified GE lesions in 36 T-TEER (45.5%) and 27 M-TEER (30.7%) pts. There was no Forrest lesion Ia.
• Forrest Ib (active oozing bleeding): 3 (3.4%) vs 2 (2.3%)
• Forrest IIa (recent bleeding with visible vessel): 2 (2.5%) vs 2 (2.3%)
• Forrest IIb (recent bleeding with adherent clot): 19 (24.1%) vs 10 (11.4%)
• Forrest IIc (recent bleeding covered with haematin): 5 (6.3%) vs 4 (4.5%)
• Forrest III (non bleeding): 7 (8.9%) vs 9 (10.3%)
13 pts (16.5%) from the T-TEER and 8 pts (9.1%) from the M-TEER group required an endoscopic treatment with hemoclips to stop or prevent a GE bleeding, p=0.168. The intervention time in pts treated with hemoclips was significantly longer with 108.0 ± 10.4 min comparing to the pts who didn’t receive hemoclips with 87.1 ± 3.4 min, p=0.036.
The pts who were treated with hemoclips received on average 2,43 devices to reduce the regurgitation in comparison to the other pts with 1,66 devices, p=0.0004.
According to the ROC curve the cutoff intervention time of 91.5 min is associated with an increased risk for lesions requiring hemoclip treatment with a sensitivity of 61.9% and specificity of 69.2% (Youden Index of 0.311).
Conclusion:
Our study shows that major injury and GE-bleeding requiring endoscopic treatment post-TEER are rare, but can occur with longer intervention time even in asymptomatic patients.
Therefore, we would recommend performing gastroscopy after TEER procedure with longer intervention times (> 91,5 min) especially for pts needing anticoagulation therapy.
