ELMSTREET (Esophageal Lesions during MitraClip uSing TRansEsophageal Echocardiography Trial)

EuroIntervention. 2017 Dec 8;13(12):e1444-e1451. doi: 10.4244/EIJ-D-17-00125.

Abstract

Aims: We aimed to evaluate possible detrimental effects of transoesophageal echocardiography (TEE) on the oesophageal tissue during percutaneous mitral valve repair (PMVR).

Methods and results: From March 2014 to July 2015, 186 patients were treated for severe mitral regurgitation with PMVR using the MitraClip system. In 40 patients, oesophago-gastro-duodenoscopy was performed due to symptoms related to the gastrointestinal tract. Based on the procedure duration, patients were classified into group 1 (>60 minutes, n=23) or into group 2 (<60 minutes, n=17), respectively. Oesophageal lesions (OL) were found in 19 patients (group 1: n=17 vs. group 2: n=2, p<0.0001). We observed a change in leucocyte count after the procedure (group 1: +2.00 Gpt/L [SEM±0.48] vs. group 2: +0.54 Gpt/L [SEM±0.36], p=0.028). This change was more apparent when comparing patients with OL vs. those without (lesions: +2.65 Gpt/L [SEM±0.56] vs. no lesions: +0.23 Gpt/L [SEM±0.12], p<0.0001).

Conclusions: Prolonged use of TEE during PMVR with a procedure time of longer than 60 minutes increases the risk of oesophageal damage. An exceptional rise of leucocyte count after PMVR may raise suspicion of new oesophageal damage.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Echocardiography, Transesophageal / adverse effects*
  • Endovascular Procedures*
  • Esophagus / injuries*
  • Female
  • Humans
  • Male
  • Mitral Valve Insufficiency / surgery*
  • Prospective Studies
  • Registries*