C-6 | Safety of transesophageal echocardiography in patients referred for tricuspid valve disease prior to structural cardiac interventions

Transcatheter tricuspid valve interventions are a novel and effective therapeutic option for the treatment of tricuspid regurgitation (TR). Despite the widespread use of transesophageal echocardiography (TEE) to evaluate for valve pathology in the general cardiology population, studies are lacking regarding the safety of this procedure in patients with severe TR. This was a retrospective analysis of patients referred to our center to evaluate severe TR prior to pre-procedural planning. We analyzed the baseline characteristics and adverse events of patients between the years of 2022-2023 who were being evaluated for Transcatheter based options and were referred for TEE prior to final decision on treatment options. Among 107 patients undergoing TEE from 07/1/2022 to 06/30/2022 there was a high burden of comorbidities- atrial fibrillation in 69.2%, hypertension in 82.2% and heart failure in 89.7%. On baseline TTE images, 24% patients had severe dilation of RV and 12.4% had severe impairment of RV function. Median RV basal diameter was 4.9 mm, and median RV fractional area contraction was 35.8%. On TEE, 27.4% patients had severe dilation of RV and 7.8% patients had severe impairment of RV function. Median RV basal diameter was 5.5 mm. Median RV fractional area contraction was 33.6%. Incidence of primary outcome was 28% (30/107, hypotension requiring treatment in 29, hospitalization on 7, Cardiac arrest in 3- and 30-day mortality in 3). Prevalence of comorbidities was similar with a higher prevalence of atrial fibrillation among those with primary outcome. On TTE, these patients had worse RV function (median FAC 27.9 vs. 37.9%, p=0.004). There was higher prevalence of severe RV dysfunction among those with primary outcome (14% vs. 5.0%, p=0.039). Among subset of patients undergoing RHC, there was no difference in hemodynamic variables. In this single center study of consecutive referred patients undergoing TEE for pre-procedural assessment of TR severity prior to structural cardiac interventions, there was a high prevalence of adverse outcomes. Patients with adverse outcomes had a higher prevalence of atrial fibrillation, and worse indices of RV dysfunction.