https://doi.org/10.1007/s00392-025-02737-x
1Medizinische Universität Lausitz-Carl Thiem 1. Medizinische Klinik, Kardiologie, Rhythmologie und Angiologie Cottbus, Deutschland; 2Medizinische Universität Lausitz - Catrl Thiem 4. Medizinische Klinik, Gastroenterologie & Rheumatologie Cottbus, Deutschland
Background:
Transcatheter edge-to-edge repair (TEER) is a minimally invasive procedure for treating severe mitral or tricuspid regurgitation in patients at high surgical risk. Transesophageal echocardiography (TEE) plays a crucial role in guiding these interventions. However, data on TEE-associated gastroesophageal (GE) lesions, especially in asymptomatic patients, and comparative studies between M-TEER and T-TEER are limited.
Purpose:
The aim of our study is to compare the incidence, type, and clinical impact of TEE-related silent GE lesions in patients undergoing M-TEER and T-TEER. This is particularly important because the majority of patients required immediate oral anticoagulation following the procedure. As the gastric view is regularly required during T-TEER procedure, there might be an increased risk of gastric or esophageal injury in comparison to M-TEER.
Methods:
We analysed a total of 103 high-risk patients who underwent TEER at our institution: 53 underwent T-TEER and 50 underwent M-TEER. Esophagogastroduodenoscopy (EGD) was performed the day after the procedure to assess for GE lesions. All patients received perioperative IV pantoprazole (40 mg). Lesions were categorized using the Forrest classification for upper GI bleeding. Procedures were performed under general anesthesia with full heparinization (ACT > 250 seconds).
Results:
Baseline characteristics were comparable between groups (mean age: 80.9±0.6 vs 80±0.9 years; p=0.08). No significant differences were observed in BMI, EuroScore I/II, renal function, or comorbidities (AFib, Coronary Artery Disease, hypertension, hyperlipidemia, diabetes). Procedure duration was significantly longer for T-TEER (113.5±6.3 min) compared to M-TEER (70.1±4.8 min), p=0.002.
EGD identified GE lesions in 27 T-TEER and 16 M-TEER patients. Lesions were classified as follows (T-TEER vs. M-TEER): Forrest Ia 0 (0%) in both groups, Forrest Ib: 2 (3.8%) vs 1 (2%), Forrest IIa: 1 (1.9%) vs 2 (4%), Forrest IIb: 14 (26.4%) vs 4 (8%), Forrest IIc: 3 (5.7%) vs 2 (4%) and Forrest III: 7 (13.2%) vs 7 (14%)
The remaining patients (58.3%) had no or only minor non-classifiable findings (e.g. hematomas).
No statistically significant difference was found in the rate of GE lesions requiring treatment between the two groups (T-TEER: 9 patients [17%] vs. M-TEER: 5 patients [10%], p=0.066). However, patients who required GE clip placement had significantly longer procedural times: T-TEER: 140.3±17.6 min vs 105.5±7.8 min (p=0.036) and M-TEER: 114.1±15.7 min vs 88.5±5.1 min (p=0.035)
Conclusion:
Silent GE lesions after TEER are not uncommon, even in asymptomatic patients. While the overall rate of clinically significant injuries requiring intervention remains low, longer procedural time is associated with an increased risk of such lesions. Importantly, there was no significant difference in the need for treatment between M-TEER and T-TEER.