Augustin Coisne1, Julien Dreyfus2, Yohann Bohbot3, Vincent Pelletier4, Edouard Collette5, Arthur Cescau6, Eve Cariou7, Cécile Alexandrino8, Sophie Coulibaly9, Aurélien Seemann10, Clément Karsenty11, Alexis Theron12, Thibault Caspar13, Laurie Soulat-Dufour14, Julien Ternacle4. 1. Department of clinical physiology and echocardiography, Heart Valve Clinic, Institut Cœur-Poumon, CHU de Lille, 59000 Lille, France. Electronic address: augustin.coisne@chru-lille.fr. 2. Department of cardiology, Centre Cardiologique du Nord, 93200 Saint-Denis, France. 3. Department of cardiology, Amiens University Hospital, 80054 Amiens, France. 4. Department of cardiology, SOS Endocardites, Henri-Mondor Hospital, 94010 Creteil, France. 5. Department of cardiology, CHU de Rennes, 35000 Rennes, France. 6. Department of cardiology and radiology, Lariboisière Hospital, 75010 Paris, France. 7. Department of cardiology, CHU de Toulouse, 31059 Toulouse, France. 8. Department of cardiology, CHU de Bordeaux, 33604 Pessac, France. 9. Department of cardiology, CHU de Tours, 37000 Tours, France. 10. NCT+ Saint Gatient Alliance, Institut Cardiologique Saint-Gatien, 37000 Tours, France. 11. Department of cardiology, European Hospital Georges-Pompidou, 75015 Paris, France. 12. Department of cardiac surgery, La Timone Hospital, Aix-Marseille University, 13005 Marseille, France. 13. Nouvel Hôpital Civil, Strasbourg University Hospital, 67091 Strasbourg, France. 14. Department of cardiology, Saint-Antoine Hospital, 75012 Paris, France.
Abstract
BACKGROUND: Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice. AIMS: To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings. METHODS: Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination. RESULTS: Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P<0.0001]). The visual analogue scale (VAS) score after TOE was good (8.3±1.7 out of 10), and was better in patients with general anaesthesia (GA) than in those without GA (9.3±0.9 vs. 8.1±1.7; P<0.0001). In patients without GA, the VAS score was similar with and without local anaesthesia (8.1±1.7 vs. 8.2±1.6; P=0.19). After multivariable adjustment, absence of anxiety before TOE and greater operator experience were consistently associated with a higher VAS score. CONCLUSIONS: TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.
BACKGROUND: Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice. AIMS: To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings. METHODS: Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination. RESULTS: Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P<0.0001]). The visual analogue scale (VAS) score after TOE was good (8.3±1.7 out of 10), and was better in patients with general anaesthesia (GA) than in those without GA (9.3±0.9 vs. 8.1±1.7; P<0.0001). In patients without GA, the VAS score was similar with and without local anaesthesia (8.1±1.7 vs. 8.2±1.6; P=0.19). After multivariable adjustment, absence of anxiety before TOE and greater operator experience were consistently associated with a higher VAS score. CONCLUSIONS: TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.
Authors: Jean Timnou Bekouti; Manitra Rambolarimanana; Akuvi Claude Adossou; Mialy Ravakiniaina Ranaivosoa; Roberto Prudencio; Pierre Bolarin Lawani; Alain Ranjatson; Alpha Diawara; Jean Louis Roynard Journal: Pan Afr Med J Date: 2021-03-22