Endomyocardial biopsy technique for orthotopic heart transplantation and cardiac stem-cell harvesting
1Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
Endomyocardial biopsies are safe after heart transplants and myocardial infarction for stem cell harvesting. Key techniques include ultrasound guidance and specialized equipment to ensure patient safety and procedural success.
Area of Science:
- Cardiology
- Transplantation Medicine
- Regenerative Medicine
Background:
- Orthotopic heart transplantation (OHT) utilizes either bicaval or standard biatrial anastomoses.
- Specific considerations for endomyocardial biopsy post-bicaval OHT and for cardiac stem cell harvesting after myocardial infarction remain undescribed.
Purpose of the Study:
- To describe the technical considerations for performing endomyocardial biopsy after bicaval OHT.
- To outline methods for harvesting cardiac stem cells post-myocardial infarction.
Main Methods:
- Utilized ultrasound guidance for vascular access via internal jugular vein.
- Employed a soft guidewire, long sheath, and flexible bioptome.
- Applied these techniques for both post-OHT biopsies and stem cell harvesting post-myocardial infarction.
Main Results:
- Over 754 procedures (2002-2005) and 2818 procedures (2006-2013) post-bicaval OHT, no cardiac tamponade occurred; ventricular fibrillation was rare.
- 23 biopsies for stem cell harvesting post-myocardial infarction showed no immediate complications.
- Tricuspid regurgitation was not assessed in this study.
Conclusions:
- Endomyocardial biopsy is safe following bicaval OHT and for cardiac stem cell harvesting post-myocardial infarction.
- Ultrasound guidance, long guidewires/sheaths, and flexible bioptomes are crucial for safe biopsy procedures.
Introduction:
Orthotopic heart transplantation (OHT) is performed using the bicaval and pulmonary venous anastomoses or the standard (biatrial) anastomoses. The special considerations of endomyocardial biopsy after OHT using the bicaval technique, and after myocardial infarction for harvesting of cardiac stem cells, have not been described.
Methods:
When approached via the right or left internal jugular vein, important technical considerations were ultrasound guidance for vascular access; a soft, 80-cm, 0.035-inch, J-tipped guidewire; a long (23-cm), 7-Fr sheath; and a flexible 7-Fr, 50-cm bioptome. These technical aspects were helpful to avoid disruption of the superior vena cava suture line, avoid entry into the right atrial appendage or coronary sinus, avoid right ventricular free wall perforation, and provide ready access to the right ventricular septal wall. We used the same principles and technical considerations when obtaining the cardiac stem cells after myocardial infarction in patients enrolled in the CADUCEUS trial.
Results:
From January 2002 to December 2005, 754 biopsy procedures were performed in 179 patients after OHT with the bicaval technique, using bioptome A. There was 1 occurrence of ventricular fibrillation requiring cardioversion, and no occurrence of cardiac tamponade during the procedure. From January 2006 to September 2013, 2818 biopsy procedures were performed in 1064 patients using bioptome B. No patient developed ventricular fibrillation or cardiac tamponade during the procedure. In 2010 and 2011, 23 biopsy procedures were performed in 23 patients after acute myocardial infarction, using bioptome B. No immediate complications occurred while performing these biopsies. The late occurrence of tricuspid regurgitation was not evaluated in this study.
Conclusions:
Endomyocardial biopsy procedures can be safely performed after OHT with the bicaval technique and after myocardial infarction for harvesting of cardiac stem cells. Ultrasound guidance for vascular access, a long guidewire and sheath, and a flexible bioptome are important features for the safe conduct of the biopsy procedure.
