Incidence and Associated Patient Characteristics of Gastrointestinal Bleeding Following Transesophageal Echocardiography in Transcatheter Structural Heart Interventions and Cardiac Surgery: A Descriptive Epidemiological Study.

OBJECTIVES

To describe the incidence and baseline characteristics of upper gastrointestinal bleeding (UGIB) within 3 and 7 days of transesophageal echocardiography (TEE) in transcatheter structural heart interventions (SHIs) and cardiac surgery using uniform diagnostic criteria.

DESIGN

A descriptive epidemiological study using an administrative database.

SETTING

JMDC hospital database between April 2014 and December 2023.

PARTICIPANTS

Patients aged ≥18 years who underwent SHI (n = 5,758) or cardiac surgery (n = 32,035) with same-day TEE. The exclusion criteria were multiple SHI procedures; combined SHI with cardiovascular surgery; UGIB, mechanical circulatory support, or prior TEE within 7 days preoperatively; and missing anesthesia duration data.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

The incidence proportion of UGIB within 3 days postoperatively was comparable between SHI and cardiac surgery cohorts (0.17%; 95% CI, 0.09%-0.32% v 0.18%; 95% CI, 0.14%-0.24%). Among patients with UGIB by day 7, 48% (10/21) in SHI and 57% (59/104) in cardiac surgery presented within 3 days. In-hospital mortality was higher with UGIB within 3 days than without UGIB in both the SHI (20.0% v 1.3%) and cardiac surgery (8.5% v 4.5%) cohorts. Prolonged duration of anesthesia was associated with increased UGIB in both groups. Additional factors associated with UGIB differed by procedure type.

CONCLUSIONS

Using identical diagnostic criteria, this study demonstrates similar incidence proportions of UGIB in the SHI and cardiac surgery cohorts, with approximately half of cases presenting within 3 days. The increased mortality observed in both groups underscores the need for careful monitoring for UGIB.