TY - JOUR
T1 - Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients
T2 - Results of a multicenter experience
AU - Daly, Kevin P.
AU - Marshall, Audrey C.
AU - Vincent, Julie A.
AU - Zuckerman, Warren A.
AU - Hoffman, Timothy M.
AU - Canter, Charles E.
AU - Blume, Elizabeth D.
AU - Bergersen, Lisa
N1 - Funding Information:
A Web-based application for data entry was developed in 2006 with funding support from the Children's Heart Foundation (Chicago, IL). The application was deployed on a Microsoft Internet Information Server obtained with funding support from the American Heart Association. The American Heart Association Physicians Roundtable Award (AHA-PRA) provides support for the project and career development plan for Dr Bergersen (2006–2011). Dr Daly received salary support from a National Institutes of Health training grant ( T32 HL07572 ) and the Children's Hospital Boston Cardiac Transplant and Education Fund while working on this study.
PY - 2012/4
Y1 - 2012/4
N2 - 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.
AB - 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.
KW - biopsy
KW - coronary angiography
KW - heart transplantation
KW - pediatrics
KW - safety
UR - http://www.scopus.com/inward/record.url?scp=84858338395&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2011.11.019
DO - 10.1016/j.healun.2011.11.019
M3 - Article
C2 - 22209354
AN - SCOPUS:84858338395
SN - 1053-2498
VL - 31
SP - 398
EP - 409
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 4
ER -