Background
Patients with right cardiac decompensation often suffer from retrograde hepatic venous congestion with subsequent gastropathy and hyperemia of the gastric mucosa. Due to increased portal pressure as well as possible cirrhosis cardiaque, the risk for esophageal varices is greatly increased. In addition, with atrial dilatation, these patients usually have atrial fibrillation and receive an OAK/DOAK as insult prophylaxis. Heparinization with a target ACT > 250 is necessary as part of the TriClip procedure, and alternation between transgastric and midesophageal position with the transesophageal ultrasound probe is usually performed to guide clip implantation. Good wall contact is crucial for good imaging. The aim of this study was to assess the frequency and risk factors of mechanical irritation and bleeding caused by TEE probe in the setting of TriClip intervention.

Methods
Patients in this retrospective cohort trial underwent gastroscopy prior to intervention and the day following TriClip procedure. SPSS.28 was used to conduct the statistical analysis to compare patients with and without postinterventional lesions in respect to demographic traits, risk variables as well as the administration of an oral anticoagulation therapy.

Results
From December 2020 to July 2022, 40 patients with indication for TriClip procedure were included in this study. Twenty-four of 40 patients (60%) showed gastric or oesophageal lesions postinterventionally, 8 patients (20%) required hemoclip therapy (Fig. 1).

Both groups had no significant differences in sex, age, presence of leads, ascites, coronary heart disease or previous heart surgery (Tab. 1). On the other side, patients with hypertension (p value:0,01) and low BMI (p value: 0,04) demonstrated a higher risk for bleeding. Of the patients who presented an injury after the procedure, it was observed that all of them received an oral anticoagulant, due to atrial fibrillation (Tab.1).

Conclusion
Sixty percent of patients undergoing TriClip intervention had postprocedural injuries (lesions) of the esophagus.  Due to the procedure as well as the severe underlying disease, gastrointestinal bleeding is a potential complication in the context of a TriClip procedure. Most of the patients received an oral anticoagulant for insult protection. Due to the high incidence of procedure-related lesions, further research on higher patient collectives is necessary.