Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: Results of a multicenter experience

Kevin P. Daly, Audrey C. Marshall, Julie A. Vincent, Warren A. Zuckerman, Timothy M. Hoffman, Charles E. Canter, Elizabeth D. Blume, Lisa Bergersen

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Background: No prior reports documenting the safety and diagnostic yield of cardiac catheterization and endomyocardial biopsy (EMB) in heart transplant recipients include multicenter data. Methods: Data on the safety and diagnostic yield of EMB procedures performed in heart transplant recipients were recorded in the Congenital Cardiac Catheterization Outcomes Project database at 8 pediatric centers during a 3-year period. Adverse events (AEs) were classified according to a 5-level severity scale. Generalized estimating equation models identified risk factors for high-severity AEs (HSAEs; Levels 35) and non-diagnostic biopsy samples. Results: A total of 2,665 EMB cases were performed in 744 pediatric heart transplant recipients (median age, 12 years [interquartile range, 4.8, 16.7]; 54% male). AEs occurred in 88 cases (3.3%), of which 28 (1.1%) were HSAEs. AEs attributable to EMB included tricuspid valve injury, transient complete heart block, and right bundle branch block. Amongst 822 cases involving coronary angiography, 10 (1.2%) resulted in a coronary-related AE. There were no myocardial perforations or deaths. Multivariable risk factors for HSAEs included fewer prior catheterizations (p = 0.006) and longer case length (p < 0.001). EMB yielded sufficient tissue for diagnosis in 99% of cases. Longer time since heart transplant was the most significant predictor of a non-diagnostic biopsy sample (p < 0.001). Conclusions: In the current era, cardiac catheterizations involving EMB can be performed in pediatric heart transplant recipients with a low AE rate and high diagnostic yield. Risk of HSAEs is increased in early post-transplant biopsies and with longer case length. Longer time since heart transplant is associated with non-diagnostic EMB samples.

Original languageEnglish
Pages (from-to)398-409
Number of pages12
JournalJournal of Heart and Lung Transplantation
Volume31
Issue number4
DOIs
StatePublished - Apr 1 2012

Keywords

  • biopsy
  • coronary angiography
  • heart transplantation
  • pediatrics
  • safety

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