Risk of complications related to common heart scan unveiled in largest study of its kind

Risk of complications related to common heart scan unveiled in largest study of its kind

A new study, published in the journal Anaesthesia, today (June) has provided a better understanding of complications related to Transoesophageal Echocardiography (TOE) in the largest study of its kind. TOE is a standard and widely-used ultrasound scan of the heart that is commonly performed in patients who are either sedated or asleep. This study particularly looked at its use in patients who were asleep (anaesthetised) and undergoing surgery or other procedures for heart disease.

The use of TOE has increased greatly over the last 20 years and it is now regarded as standard practice during many cardiac surgery and cardiology procedures. It involves a large, fairly rigid probe being inserted into a patient’s mouth and down into their oesophagus. It allows the doctor to check the structure of the heart and see how well it is functioning and to detect any abnormalities or problems.

Previous studies of the use of TOE have suggested a low complication rate. However, this new study, the largest of its kind and covering > 80% of all NHS cardiac surgical units in the UK and Ireland over a 12-month period, found that the risk was higher than previously reported. Major complications occurred in approximately 1:1300 procedures and approximately 1:3000 died as a direct result of complications of TOE (as opposed to the surgery itself). In this study seven out of 17 patients with major complications died; in other words, if a patient develops a major complication, there is an associated 40% risk of mortality.

The majority of major complications occurred unexpectedly and commonly involved gastro-intestinal bleeding. The most likely mechanism was damage when inserting the probe into the patient’s mouth and oesophagus or when moving the probe from the oesophagus and out of the stomach.

Dr Nick Fletcher, Consultant Cardiac Anaesthetist from St Georges in London and one of the study authors, said: “This large national study demonstrates that there is a small but definite risk of major complications and death related to TOE use in cardiac surgery, probably due to probe insertion and manipulation. The procedure is considered to be necessary for many types of cardiac surgery and is safe in the vast majority of cases. We recommend all clinicians and departments review their procedural guidelines together with the information communicated to patients when the risks and benefits of such examinations are discussed.”

Dr Moyna Bill, President of the Association of Cardiothoracic Anaesthesia and Critical Care, said: “This prospective audit shows us the value of the multicentre audits carried out by our members across the various units in the UK and Ireland. It reminds us, as clinicians, to be mindful of the benefits and possible complications of the procedures that we commonly use in our daily work to deliver safe and effective anaesthesia and critical care for our patients. This up-to-date information should help us to adequately prepare our patients during the ‘consent for operation’ process.”