P643Is transoesophageal echocardiography under conscious sedation safe in high risk patients considered for TAVI?


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Abstract

Background: Transoesophageal echocardiography (TOE) is a widely used imaging modality in ambulatory patients, with a reportedly low complication rate. TOE is frequently performed under conscious sedation. It is the imaging modality of choice for assessment of aortic valve morphology and size prior to trans-catheter aortic valve implantation (TAVI). However, the population of patients undergoing workup for TAVI differs from the general TOE population, as they have been turned down for conventional surgery due to high operative risk. Therefore, we sought to establish whether the complication rate for patients undergoing TOE as part of TAVI work-up is higher than the risk for the general TOE population.Methods: We reviewed the registry of all patients who underwent TAVI work up at our institution and identified patients who underwent TOE as part of TAVI work up. TOE was performed by a cardiologist assisted by a nurse and an echocardiographer. When sedation was used, it was administered by the cardiologist. We calculated logistic Euroscore as a measure of patient risk and reviewed the TOE records for sedation use and major complications (failed procedure, arrhythmia, desaturation, laryngospasm, reversal of sedation, major upper GI bleeding or trauma, death). Minor complications such as sore throat were not recorded. Where there was doubt as to outcome or a complication was documented, a full review of the medical record was performed.Results: We identified 77 patients who underwent TOE during TAVI workup between November 2007 and May 2011. Mean patient age was 83.3 ±6.6 years and 37 (48.1%) patients were aged ≥85y. Median Euroscore was 23.0% (Range 6-69%). Mean FEV1/FVC was 64±12.3%. 44 (57.1%) patients had moderate or severe COPD, defined as FEV1/FVC ratio <70%. 82% of patients underwent TOE under conscious sedation. Median dose of Midazolam administered was 2mg. The TOE probe could not be inserted in 2 (2.6%) patients. No other complications occurred.Conclusion: TOE may safely be performed under sedation in high risk patients undergoing TAVI work up.

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