title: Comparative analysis of the complications of 5347 endomyocardial biopsies applied to patients after heart transplantation and with cardiomyopathies: a single-center study.
abstract: BACKGROUND
  Endomyocardial biopsy (EMB) plays an important role in allograft surveillance to screen an acute rejection episode after heart transplantation (HT), to diagnose an unknown cause of cardiomyopathies (CMP) or to reveal a cardiac tumor. However, the procedure is not risk free.
  
  
  OBJECTIVE
  The main objective of this research was to describe our experience with EMB during the last 33 years comparing surgical risk between HT versus no-HT patients.
  
  
  METHODS
  We analyzed retrospectively the data of 5347 EMBs performed from 1978 to 2011 (33 years). For surveillance of acute rejection episodes after HT we performed 3564 (66.7%), whereas 1777 (33.2%) for CMP diagnosis, and 6 (1.0%) for cardiac tumor identification.
  
  
  RESULTS
  The main complications due to EMB were divided into 2 groups to facilitate analysis: major complications associated with potential death risk, and minor complications. The variables that showed a significant difference in the HT group were as follows: tricuspid injury (.0490) and coronary fistula (.0000). Among the no-HT cohort they were insufficient fragment (.0000), major complications (.0000) and total complications (.0000).
  
  
  CONCLUSIONS
  EMB can be accomplished with a low risk of complications and high effectiveness to diagnose CMP and rejection after HT. However, the risk is great among patients with CMP due to their anatomic characteristics. Children also constitute a risk group for EMB due to their small size in addition to the heart disease. The risk of injury to the tricuspid valve was higher among the HT group.
authors.affiliation: Heart Institute of Sao Paulo University Medical School, Sao Paulo, Brazil. fiorelliai@uol.com.br
authors.forename: A I
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: L
authors.initials: L
authors.lastname: Benvenuti
authors.forename: V
authors.initials: V
authors.lastname: Aielo
authors.forename: A Q
authors.initials: AQ
authors.lastname: Coelho
authors.forename: J F
authors.initials: JF
authors.lastname: Palazzo
authors.forename: R
authors.initials: R
authors.lastname: Rossener
authors.forename: A C P
authors.initials: AC
authors.lastname: Barreto
authors.forename: C
authors.initials: C
authors.lastname: Mady
authors.forename: F
authors.initials: F
authors.lastname: Bacal
authors.forename: E
authors.initials: E
authors.lastname: Bocchi
authors.forename: N A G
authors.initials: NA
authors.lastname: Stolf
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology; D001706:Biopsy / Q000009:adverse effects* / Q000401:mortality; D001938:Brazil; D009202:Cardiomyopathies / Q000209:etiology / Q000473:pathology*; D016009:Chi-Square Distribution; D004699:Endocardium / Q000473:pathology*; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006335:Heart Injuries / Q000209:etiology; D006338:Heart Neoplasms / Q000209:etiology / Q000473:pathology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000293:injuries