Abstract 11680: Modified versus Standard Endomyocardial Biopsy Technique: A Comparison of Fluoroscopy Time, Total Procedure Time, and Complications

Abstract

Background: Patients who have undergone orthotopic heart transplant (OHT) undergo frequent endomyocardial biopsies (EMBx) to assess for rejection. Difficulty crossing the superior venous caval anastomosis and tricuspid valve often complicates these procedures. We studied a new approach in which a peel-away sheath is placed in the right internal jugular vein through which a Swan-Ganz catheter is then inserted and advanced. Following right heart catheterization, the peel-away sheath is removed and a long biopsy sheath is advanced over the Swan-Ganz catheter, which is then removed, leaving the long sheath behind for advancement of the bioptome into the right ventricle. Objective: To compare fluoroscopy (fluoro) time, procedure time, and complications between a modified and standard approach to EMBx. Methods: We included patients who underwent OHT and had EMBx data available for review at two University-affiliated institutions. We excluded EMBx cases that combined a left heart catheterization. We compared fluoro time and procedure time between modalities using mixed effects gamma regression with operators and patients both included as random effects. Results: We analyzed 964 (198 modified, 766 standard) EMBx cases in 71 patients who underwent OHT from 2017 to 2022. The mean patient age was 53.9 at time of OHT; 14% (n=10) were female. Median fluoro time was 2.8 and 4.9 minutes, and median procedure time was 27 and 29 minutes, for the modified and standard approach, respectively. Cases performed using the modified approach had a shorter fluoro time by 28%, and a shorter procedure time by 7% as compared to the standard approach (Ratio=0.72, 95% CI: 0.62 ~ 0.84, p<0.001 for fluoro time; Ratio=0.93, 95% CI: 0.87 ~ 0.98, p=0.014 for total procedure time). Only one complication was identified. Conclusion: In this cohort, a modified approach to EMBx was associated with reduced fluoroscopy and procedure time as compared to the standard approach with no difference in complications.