Original articles
Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients

https://doi.org/10.1053/j.jvca.2005.01.020Get rights and content

Objective: The aim of this audit was to determine the incidence of major gastrointestinal (GI) complications associated with intraoperative transesophageal echocardiography (TEE) in adult cardiac surgical patients in this institution.

Design: Retrospective database audit.

Setting: University-affiliated teaching hospital.

Participants: Eight hundred fifty-nine consecutive cardiac surgical patients.

Interventions: None.

Measurements and Main Results: The records of all patients who developed a major upper GI complication within 30 days of cardiac surgery between January 2001 and May 2003 were examined. The patients were identified by cross-referencing cardiac surgery and endoscopy databases. A major GI complication was defined as a perforation of the esophagus or stomach or upper GI bleeding requiring transfusion, endoscopic, or surgical intervention. Early presentation was defined as <24 hours; late presentation was defined as >24 hours. During the audit period, 859 patients underwent cardiac surgery. Five hundred sixteen patients had cardiac surgery with TEE (group 1), and 343 patients had cardiac surgery without TEE (group 2). Six patients were identified, 1.2% (95% confidence interval [CI], CI, 0.5%-2.5%) in group 1 who had a major upper GI complication consistent with TEE injury. Two patients, 0.38% (95% CI, 0.05%-1.40%), presented early, and 4 patients, 0.76% (95% CI, 0.21%-1.98%), presented late. One patient in group 2 developed a major upper GI complication, 0.29% (95% CI, 0.01%-1.6%).

Conclusion: The incidence of major GI complications attributed to TEE in this group of cardiac surgical patients was higher than previously reported. Late presentation was more common than early presentation. Previous studies that have not included late presentations may have underestimated the true incidence of major GI complications related to TEE.

Section snippets

Methods

The authors’ center is a 480-bed university-affiliated tertiary referral center. The center performs 350 to 400 cardiac cases a year and has 5 dedicated cardiac anesthesiologists. Intraoperative TEE has been performed at the center since August 2000. The audit population comprised consecutive adult cardiac surgical cases performed from January 2001 until May 2003.

Patients were categorized into 2 groups. Group 1 had cardiac surgery with intraoperative TEE, and group 2 had cardiac surgery without

Results

There were 859 patients who underwent cardiac surgery in the study period, 516 of whom had a TEE performed (group 1) and 343 who did not (group 2) (Fig 1). Patients in group 1 underwent CPB more frequently and had significantly higher Parsonnet scores, longer mean CPB times, and cross-clamp times (Table 1). The incidence of major GI complications after cardiac surgery in group 1 was 1.2% (95% confidence interval, CI, 0.53%-2.5%). Two patients (0.38%, 95% CI, 0.05%-1.40%) presented early and 4

Discussion

In this retrospective audit, the incidence of major GI complications after cardiac surgery was higher in patients who had undergone intraoperative TEE than those who did not undergo TEE (1.2% v 0.29%). Furthermore, all major GI complications in group 1 were considered to be possibly TEE related.

The rate of upper GI complications after cardiac surgery is low (0.8–1.4%),7, 8 and the incidence of TEE-related complications after cardiac surgery is even lower (0.01–0.04%).1, 2 In this audit, the

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