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March 15, 2023 — Researchers at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine published a study in the Journal of the American Society of Echocardiography showing that transesophageal echocardiography-guided transcatheter structural intervention was associated with a major complication in 3.6 percent of patients.
“In patients who are at higher risk of complications from open-heart surgery, minimally invasive procedures known as percutaneous transcatheter interventions are preferred,” said Ammar Hasnie, M.D., a resident in the UAB Department of Medicine and first author of the manuscript. “During this procedure, the interventional cardiologists insert a thin, flexible catheter through a small incision in the groin and complete the intervention with TEE guidance. TEE provides real-time imaging of the heart and nearby structures during these procedures and guides the interventionalist to successfully perform these lifesaving high-risk procedures. Although TEE-guided structural interventions have become more common over the years, the complications due to the TEE probe used during the procedure have not been studied previously.”
The research team analyzed the clinical outcomes of more than 12,000 patients who had a TEE-guided percutaneous transcatheter intervention from the TriNetX database. Over the past decade, 3.6 percent of patients who had this procedure had complications — the most frequently reported complication was gastrointestinal bleeding. Major risk factors for complications included advanced age and medications such as antiplatelet or anticoagulant therapy.
“Though TEE is an excellent tool to guide minimally invasive interventions in the heart, it is not a procedure free of risk,” Hasnie said. “Long probe manipulation time during transcatheter structural cardiac interventions can lead to a higher frequency of TEE-related complications. This is especially important to consider in older patients with multiple comorbidities.”
“These findings are important in decision-making for patients undergoing structural intervention with TEE guidance in this high-risk population,” said Garima Arora, M.D., the senior author of the paper and director of Interventional Echocardiography and co-director of Echocardiography and Cardiac MRI at UAB.
According to Arora, percutaneous structural heart interventions provide a viable alternative to patients who are deemed high risk for cardiac surgery. TEE plays an integral role in guiding such interventions by providing a visual roadmap during the procedures.
“This study quantified the frequency of TEE-related complications in patients who underwent percutaneous interventions,” Arora said. “We found that the rate of TEE-related complications was modestly higher during percutaneous interventions compared with cardiac surgery, which may be attributed to the better clinical profile of patients undergoing cardiac surgery. However, the benefits of TEE-guided percutaneous interventions far outweigh the minimal increase in the risk of complications.”
As more patients undergo minimally invasive structural interventions, it is important to be aware of the risks associated with the TEE. Arora noted that this largest-to-date nationwide study will help guide cardiologists to conduct a more thorough risk assessment for patients undergoing TEE-guided percutaneous transcatheter cardiac interventions. This contemporary-era study will serve as a guide for comprehensive risk discussion with patients undergoing a minimally invasive structural cardiac intervention with TEE guidance.
For more information: www.uab.edu
June 30, 2022 
