title: Major complications related to the use of transesophageal echocardiography in cardiac surgery.
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence of injury associated with transesophageal echocardiography (TEE injuries) in cardiac surgery.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  University-affiliated hospitals.
  
  
  METHODS
  Four thousand seven hundred eighty-four patients, 89% of all public hospital cardiac surgery patients in Victoria, from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database undergoing cardiac surgery with TEE between July 1, 2005, and June 30, 2007. Because ASCTS did not record TEE use before July 2005, it was assumed that 89% of an additional 11,719 cardiac surgery patients between July 2001 and June 2005 also had TEE.
  
  
  METHODS
  The authors searched the ASCTS database for cardiac surgery patients who also had endoscopy and/or noncardiac surgery. The files of these patients were screened for possible esophageal or gastric tears or perforations. An expert panel determined likely TEE injuries.
  
  
  RESULTS
  There were 6 TEE complications from July 1, 2005, to June 30, 2007 (13/10,000 patients). There were a further 8 TEE complications before June 30, 2005, an extrapolated overall rate of 9/10,000 TEE (95% confidence interval, 5-16/10,000). TEE complications were more frequent in patients more than 70 years old (relative risk [RR], 3.7; p = 0.03) and women (RR, 6.5; p < 0.001). Three patients with TEE injury died (2/10,000).
  
  
  CONCLUSIONS
  TEE is associated with an incidence of major injuries of about 1 per 1,000 patients, with older women having a much higher risk. TEE use in cardiac surgery should be evaluated in the light of practice guidelines and morbidity and mortality data and not considered routine.
authors.affiliation: Department of Anesthesia and Critical Care, Goulburn Valley Health, Shepparton, Victoria, Australia. Mathew.Piercy@gvhealth.org.au
authors.forename: Mathew
authors.initials: M
authors.lastname: Piercy
authors.forename: Larry
authors.initials: L
authors.lastname: McNicol
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.forename: David A
authors.initials: DA
authors.lastname: Story
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies