Safety of Transesophageal Echocardiography in Patients Referred for Tricuspid Valve Disease at a Center for Structural Heart Disease.

OBJECTIVES

The aim of this study was to examine safety outcomes in patients referred for transesophageal echocardiograms (TEEs) for tricuspid valve disease.

DESIGN

Retrospective observational study.

SETTING

Single quaternary referral center specializing in structural heart disease.

PARTICIPANTS

One hundred five patients referred for TEE for tricuspid valve disease between July 2022 and June 2023.

INTERVENTIONS: This study was not interventional, but assessed the safety of TEE.

METHODS AND MAIN

RESULTS

The primary outcome was a composite of hypotension (mean arterial pressure [MAP] < 60 mmHg); use of epinephrine, norepinephrine, or calcium chloride; aborted studies due to documented clinical instability; emergent intubation; hospitalization or escalation of care post-TEE; oropharyngeal or gastrointestinal injury; or cardiac arrest. Secondary outcomes were 30-day cardiovascular mortality, all vasopressor use, and time spent per TEE. The primary outcome was noted in 32 patients (30.5%). The rate of cardiac arrest was 2.9% (3/105). Hypotension (MAP < 60 mmHg) was noted in 30 patients, with 7 patients needing hospitalization after TEE. No patients had oropharyngeal or gastrointestinal injury. There was a greater prevalence of moderate to severe right ventricular (RV) dilation (77% vs 53%; p = 0.022) and moderately to severely decreased RV function (48% vs 25%; p = 0.023) in patients who met the primary outcome. Both RV fractional area change (37.9% vs 29.8%; p = 0.003) and tricuspid annular plane systolic excursion (1.84 cm vs 1.45 cm; p = 0.002) were lower on baseline transthoracic echocardiogram.

CONCLUSIONS

Patients with severe tricuspid regurgitation had a high prevalence of adverse events when undergoing TEE. Further studies are needed to compare these outcomes with other groups undergoing diagnostic TEE and delineate what risk factors may place these patients at greater risk.