Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: results of a multicenter experience.
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 3-5) 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.
Department of Cardiology, Children's Hospital Boston and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA. kevin.daly@childrens.harvard.edu
Kevin P
KP
Daly
Audrey C
AC
Marshall
Julie A
JA
Vincent
Warren A
WA
Zuckerman
Timothy M
TM
Hoffman
Charles E
CE
Canter
Elizabeth D
ED
Blume
Lisa
L
Bergersen
D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology*; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D014180:Transplantation