Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study

Background Although there have been several large reviews documenting the complications following intraoperative transesophageal echocardiography (TEE), most of these prior reports are almost 2 decades old and may not reflect current practices. The purpose of this study was to determine the incidence and types of complications following TEE in a contemporary cardiac surgical population. Methods We conducted a retrospective analysis of all cardiac surgical patients having undergone an intraoperative TEE between April 1, 2004, and April 30, 2012. Patients with TEE-related complications were identified from our institutional cardiac surgical database to have their medical records manually reviewed through International Classification of Diseases-10th Revision coding for: 1) a priori defined complications including dysphagia, vocal cord and laryngeal injury, dysphonia, accidental puncture and laceration during a procedure, and hemorrhage and hematoma complicating a procedure; 2) the requirement for an in-hospital esophageal or bronchial endoscopy procedure; or 3) the requirement for postoperative specialist consultation from gastrointestinal bleed or other surgery services. A multivariable model was then developed to identify risk factors for TEE complications. Results Of the 7,954 cardiac surgical cases performed during the study period, 1,074 had their records manually reviewed and 111 (1.4%) patients had possible complications. Multivariate analysis showed an increased risk of complications associated with age, body mass index, previous stroke, procedure other than isolated coronary artery bypass grafting, cardiopulmonary bypass time, and return to the operating room for any reason (model c-statistic = 0.81). Conclusions The overall incidence of TEE complications after cardiac surgery was 1.4%. Advanced age, low body mass index, complexity of procedure, prior stroke, prolonged bypass time, and return to the operating room appear to be significant risk factors for TEE complications.