[Safety analyses from 439 patients underwent endomyocardial biopsy via the right internal jugular vein approach]
Jie Huang1, Yue-jin Yang, Dong Yin
1Heart Transplantation Center, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Insights
Endomyocardial biopsy (EMB) via the right internal jugular vein is safe, with a very low complication rate. This study found no major complications in 439 EMB procedures, demonstrating its safety for heart transplant surveillance and diagnosing heart conditions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Biopsy
Background:
- Endomyocardial biopsy (EMB) is crucial for heart transplant rejection surveillance and diagnosing cardiomyopathies or myocarditis.
- Concerns regarding potential complications have limited widespread acceptance of EMB procedures.
- This study evaluates the safety and complication rates of EMB.
Purpose of the Study:
- To analyze the incidence of major and minor complications associated with endomyocardial biopsy (EMB) procedures.
- To assess the safety of EMB performed via the right internal jugular vein approach.
- To determine the complication rate in a large cohort of EMB procedures.
Main Methods:
- A retrospective analysis of 439 EMB procedures performed over 4.5 years.
- Procedures utilized a modified Cordis bioptome via the right internal jugular vein approach under fluoroscopic guidance.
- Pre- and post-procedure evaluations included ECG, ambulatory ECG monitoring, chest X-ray, and echocardiography.
Main Results:
- No major complications such as cardiac tamponade, hemothorax, or pneumothorax were observed.
- Minor complications included temporary right bundle branch block (RBBB) in 0.47% and sustained RBBB in 0.23%.
- Mild-moderate tricuspid regurgitation occurred in 0.91% of cases; no A-V block or complex arrhythmias were reported.
Conclusions:
- Endomyocardial biopsy via the right internal jugular vein approach under fluoroscopic guidance is a safe procedure.
- The EMB procedure is associated with a very low complication rate when performed by experienced operators.
- These findings support the safety and efficacy of EMB for cardiac indications.
Objective:
Primary indications for endomyocardial biopsy (EMB) include heart transplant rejection surveillance and identifying cardiomyopathy or myocarditis. EMB procedures have not yet gained widespread acceptance because of concerns about possible complications associated with EMB procedures. In this single-center retrospective study, we analyzed the incidence of major and minor EMB procedure-related complications of 439 EMBs during the past 4.5 years.
Methods:
From May 2004 to November 2008, 15 patients with cardiomyopathy and 1 patient with suspected cardiac tumor underwent 16 EMB procedures and 131 heart transplant recipients underwent 423 EMB procedures with the use of a modified Cordis bioptome. All EMB procedures were made via the right internal jugular vein approach and RV septum EMBs were performed under fluoroscopic guidance without additional echocardiographic monitoring. Operators were allowed to perform EMB procedure alone if a minimum of 50 EMB procedures had been previously supervised by a senior operator and all EMBs were performed by 4 operators. All patients underwent a 12-lead electrocardiogram (ECG), 12-hour continuous ambulatory ECG monitoring, chest X-ray and transthoracic echocardiography before and after EMB procedures to obtain a detailed evaluation of the incidence of conduction abnormalities, arrhythmias, pericardial effusions and worsening valve insufficiency.
Results:
There was no major complications like cardiac tamponade, hemothorax and pneumothorax. Minor complications such as conduction abnormalities including temporary RBBB (lasting < 24 h after EMB procedures) were found in 2 cases (0.47%) and sustained RBBB (> 24 h) was evidenced in 1 case (0.23%). There were no A-V block, complex ventricular arrhythmias or episodes of atrial fibrillation during and post procedure. In addition, 4 cases (0.91%)of EMB induced mild-moderate tricuspid regurgitation during the procedure were diagnosed by echocardiography.
Conclusion:
The EMB procedure via the right internal jugular vein approach under fluoroscopic guidance is safe and associated with a very low complication rate when performed by experienced operators.
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