Safety and procedural success of left appendage closure interventions with transesophageal echocardiography microprobes

Abstract

Abstract Introduction Transesophageal echocardiography (TOE) is the most frequently used imaging technique for intraprocedural guidance in left appendage closure interventions. However, it usually requires the use general anaesthesia and implies an increased risk of bleeding, and of esophageal and upper airway tract lesions. Intracardiac echocardiography and TOE with microprobes (micro-TOE) have been proposed as alternative techniques for procedural imaging. Purpose The aim of this study is to compare the results of LAAC interventions in terms of success, safety and hospital stay depending of the imaging technique used for procedural guidance. Methods This is a single-center, prospective study, which included patients in which LAAC was performed between the years 2009 and 2021. In the group with conventional TOE guidance, procedure was performed under general anesthesia using the probe Philips X8-2t. In the group with micro-TOE guidance, the procedure was performed under conscious sedation with midazolam and fentanyl with Philips S8-3t microprobe. Image quality was assessed independently by two echocardiographers. Basal characteristics, procedure length, complications and hospital length of stay were analyzed. Results Between the years 2009 and 2021, 511 LAAC procedures were performed, of which 357 were guided with TOE and 154 with microTOE. Mean age was of 77.2 ± 8 years, and 63.6% of patients were male. Successful device implantation was achieved in all patients of both groups. In 10 patients in which the scheduled imaging technique was micro-TOE were eventually perfomed with conventional TOE probe due to insufficient image quality. Procedural length was significantly reduced in patients in the micro-TOE (73 vs 51 min, p < 0.001). There were no significant differences in major complications between group. In-hospital length of stay was significantly reduced in patient with micro-TOE guidance (1.15 ± 1.9 days versus 2.2 ± 2.3 days, p < 0.001). Conclusions Transesophageal echocardiography with microprobes is a safe and efective imaging technique for procedural guidance for LAAC interventions, with procedural success and complication rates similar to conventional TOE. Furthermore, its use reduces in-hospital length of stay, enabling outpatient procedures.Table 1.Comparison between groups