Original article
Major Complications Related to the Use of Transesophageal Echocardiography in Cardiac Surgery

https://doi.org/10.1053/j.jvca.2008.09.014Get rights and content

Objective

The purpose of this study was to determine the incidence of injury associated with transesophageal echocardiography (TEE injuries) in cardiac surgery.

Design

Retrospective.

Setting

University-affiliated hospitals.

Participants

Four thousand seven hundred eighty-four patients, 89% of all public hospital cardiac surgery patients in Victoria, from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database undergoing cardiac surgery with TEE between July 1, 2005, and June 30, 2007. Because ASCTS did not record TEE use before July 2005, it was assumed that 89% of an additional 11,719 cardiac surgery patients between July 2001 and June 2005 also had TEE.

Interventions

The authors searched the ASCTS database for cardiac surgery patients who also had endoscopy and/or noncardiac surgery. The files of these patients were screened for possible esophageal or gastric tears or perforations. An expert panel determined likely TEE injuries.

Measurements and Main Results

There were 6 TEE complications from July 1, 2005, to June 30, 2007 (13/10,000 patients). There were a further 8 TEE complications before June 30, 2005, an extrapolated overall rate of 9/10,000 TEE (95% confidence interval, 5-16/10,000). TEE complications were more frequent in patients more than 70 years old (relative risk [RR], 3.7; p = 0.03) and women (RR, 6.5; p < 0.001). Three patients with TEE injury died (2/10,000).

Conclusions

TEE is associated with an incidence of major injuries of about 1 per 1,000 patients, with older women having a much higher risk. TEE use in cardiac surgery should be evaluated in the light of practice guidelines and morbidity and mortality data and not considered routine.

Section snippets

Methods

This study was conducted in Victoria, the second largest state in Australia, with a population of 5 million people. The study sample was drawn from a database maintained by the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) from July 1, 2001, until June 30, 2007. The database was searched to identify all patients who underwent a gastroscopy, laparotomy, or thoracotomy subsequent to their cardiac surgery. The medical records of all such patients (434 cases) were then examined in

Results

The ASCTS database included TEE between July 1, 2005, and June 30, 2007. For the period of July 1, 2001, to June 30, 2005, the rate of TEE use was unknown. From July 1, 2005, to June 30, 2007, 89.9% of patients had TEE during cardiac surgery. The authors extrapolated a 88.9% rate of TEE use to the 11,719 patients who underwent cardiac surgery from July 1, 2001, to June 30, 2005. The authors think that this number of 10,418 patients that was used to calculate the overall incidence of major TEE

Discussion

The authors examined the incidence of esophageal and gastric tears and perforations associated with TEE during cardiac surgery in more than 15,000 patients at 6 Australian public (government) hospitals. The overall incidence of TEE-associated injury was 9 per 10,000 patients, and mortality was 2/10,000. Furthermore, it was found that women and older patients were at a significantly greater risk of TEE-associated injury.

Although there have been many case reports,6 there have been only a few

Acknowledgment

The ASCTS Cardiac Surgery Database is an initiative of the ASCTS and is funded by the Department of Human Services, Victoria, Australia. The VCCAMM is funded by the Department of Human Services, Victoria, Australia.

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