Abstract 11152: Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions in the United States: 2012-2022

Introduction: Transesophageal echocardiograms (TEEs) performed during structural cardiac interventions may have higher complications than those performed in the non-operative setting. However, there is limited data on complications associated with TEE in these procedures. The objective of this study was to evaluate the prevalence of major complications among these patients in the United States (US). Methods: A retrospective cohort study was conducted using an electronic health record database from large academic medical centers across the US for patients undergoing TEE during structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography endorsed ICD-10 codes, patients undergoing TEE during a structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, and paravalvular leak replacement were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding, esophageal and upper respiratory tract injury). Results: A total of 9,482 adult patients undergoing TEE for transcatheter structural cardiac interventions were identified. The median age was 71 years (IQR: 61 - 80 years), including 43% females and 19% non-white individuals. Of those, 7,158 (75%) of patients were on anticoagulation, and 6,272 (66%) were on antiplatelet therapy. In the study cohort, 246 (2.6%) patients had a major complication. Complication rates were higher in patients on anticoagulation or antiplatelet therapy compared to those who were not (2.9% vs. 0.84%, p<0.001, OR: 3.57 [95% CI: 1.89- 6.74]). Patients aged ≥65 had higher rates of major complications compared with those <65 (2.95% vs. 1.16%, p<0.001). Complication rates were similar among males and females (2.7% vs 2.5%, p=0.50). Conclusions: Nearly 2.6% of patients undergoing TEE during transcatheter structural cardiac interventions have a major complication. Major complications are relatively more common among older patients and those on anticoagulant and antiplatelet therapy. With a shift of poor surgical candidates to less invasive procedures, the future of TEE-guided procedures relies on a heart team approach and a comprehensive risk discussion.