Comparison of TEE-Related Silent Gastro-Esophageal (GE) Lesions After Mitral Transcatheter Edge-to-Edge Repair (M-TEER) and Tricuspid Transcatheter Edge-to-Edge Repair (T-TEER)

Background TEER is a minimally invasive procedure used to treat severe mitral and tricuspid regurgitation in patients (pts) who are deemed high-risk for conventional surgery. The use of transoesophageal echocardiography (TEE) is crucial in guiding these complex interventions. However, there is limited data comparing the incidence and severity of TEE-related GE lesions following M-TEER and T-TEER. Purpose This study aims to compare the frequency, type and clinical outcome of GE lesions in asymptomatic pts undergoing TEER. As the gastric view is regularly required during T-TEER procedure, there might be an increased risk of gastric or esophageal injury in comparison to M-TEER. Methods At our hospital 67 pts with high surgical risk underwent T-TEER and 50 pts M-TEER. In 103 (88%) asymptomatic pts we conducted one day after the procedure esophagogastroduodenoscopy (EGD) to check for gastric lesions. All pts received pantoprazole 40 mg i.v. periinterventional. GE lesions were classified after the Forrest classification for upper gastrointestinal bleeding. In both groups, pts were administered general anesthesia and full heparinization, maintaining an activated clotting time (ACT) > 250 sec. Results 53 pts in the T-TEER-Group were compared to 50 pts in the M-TEER-Group. (Mean age 80.9±0.6 vs 80±0.9 (p=0.08), BMI 26.2±0.6 vs 27.8±1.1 (p=0.3), EuroScore I 23.6±1.6 vs 23.5±1.9 (p=0.6), EuroScore II 7±0.6 vs 6.4±0.6 (p=0.9), Creatinine 129.2±12.3 vs 125.2±7.5 µmol/L (p=0.2), BNP 961.7±205.1 vs 925.6±156.3 (p=0.4). No significant differences were observed in the comorbidities including AfiB, CAD, AHT, HLP or DM. The mean intervention time was with 113.5± 6.3 min in the T-TEER group significantly longer compared to 70.1±4.8 min in the M-TEER group. (p=0.002) Post-TEER EGD revealed 27 GE lesions in the T-TEER group and 16 GE lesions in the M-TEER group classified as following: Forrest Ia 0 (0%) in both groups, Forrest Ib 2 (3.8%) vs 1 (2%), Forrest IIa 1 (1.9%) vs 2 (4%), Forrest IIb 14 (26.4%) vs 4 (8%), Forrest IIc 3 (5.7%) vs 2 (4%) and Forrest III 7 (13.2%) vs 7 (14%). The remaining pts (58.3%) had no lesions or minimal lesions or hematoma that could not be classified according to the Forrest classification. Interestingly, there was no significant difference in GE lesions requiring treatment between both groups. 9 T-TEER pts (17%) and 5 M-TEER pts (10%) required interventional treatment with GE-clips (p=0.066). However, in both groups, pts needing GE clip therapy had a significantly longer intervention time: 140.3±17.6 min vs 105.5±7.8 min, p=0.036 for the T-TEER group and 114.1±15.7 min vs 88.5±5.1 min, p=0.035 for the M-TEER group. Conclusion Our study demonstrates that major GE injuries after TEER do occur even in asymptomatic patients but are rare. However, there was no difference in silent lesions requiring GE clip in both M-TEER and T-TEER.