Complications of Endomyocardial Biopsy in Heart Transplant Patients: A Retrospective Study of 2117 Consecutive Procedures

Saraiva, Fátima; Matos, Vítor; Gonçalves, Lino; Antunes, Manuel; Providência, Luí­s A.

doi:10.1016/j.transproceed.2011.03.010

Cited by 97 publications

(70 citation statements)

References 24 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 Longer-term complications include chronic tricuspid regurgitation (sometimes requiring valve replacement) and more rarely, coronary artery to right ventricular fistula. 4 Deaths as a direct consequence of EMB, although rare, have even been reported.…”

Section: Clinical Perspective On P 564mentioning

confidence: 99%

Randomized Pilot Trial of Gene Expression Profiling Versus Heart Biopsy in the First Year After Heart Transplant

Kobashigawa

Patel

Azarbal

et al. 2015

Circ: Heart Failure

View full text Add to dashboard Cite

Background-The endomyocardial biopsy (EMB) is considered the gold standard in rejection surveillance post cardiac transplant, but is invasive, with risk of complications. A previous trial suggested that the gene expression profiling (GEP) blood test was noninferior to EMB between 6 and 60 months post transplant. As most rejections occur in the first 6 months, we conducted a single-center randomized trial of GEP versus EMB starting at 55 days post transplant (when GEP is valid). Methods and Results-Sixty heart transplant patients meeting inclusion criteria were randomized beginning at 55 days post transplant to either GEP or EMB arms. A positive GEP ≥30 between 2 and 6 months, or ≥34 after 6 months, prompted a follow-up biopsy. The primary end point included a composite of death/retransplant, rejection with hemodynamic compromise or graft dysfunction at 18 months post transplant. A coprimary end point included change in first-year maximal intimal thickness by intravascular ultrasound, a recognized surrogate for long-term outcome. Corticosteroid weaning was assessed in both the groups. The composite end point was similar between the GEP and EMB groups (10% versus 17%; log-rank P=0.44). The coprimary end point of first-year intravascular ultrasound change demonstrated no difference in mean maximal intimal thickness (0.35±0.36 versus 0.36±0.26 mm; P=0.944). Steroid weaning was successful in both the groups (91% versus 95%). Conclusions-In this pilot study, GEP starting at 55 days post transplant seems comparable with EMB for rejection surveillance in selected heart transplant patients and does not result in increased adverse outcomes. GEP also seems useful to guide corticosteroid weaning. Larger randomized trials are required to confirm these findings. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00962377.

show abstract

Section: Clinical Perspective On P 564mentioning

confidence: 99%

Randomized Pilot Trial of Gene Expression Profiling Versus Heart Biopsy in the First Year After Heart Transplant

Kobashigawa

Patel

Azarbal

et al. 2015

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…Endomyocardial biopsy (EMB) serves as a gold standard in diagnosing graft rejection, but its invasive nature makes it prone to associated complications 2,3,4 . Therefore, there is a need for a non-invasive diagnostic tool, which would allow early, safe and reliable diagnosis of acute graft rejection prior to onset of clinical symptoms.…”

Section: Introductionmentioning

confidence: 99%

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Podroužková¹,

Bedáňová²,

Třetina³

et al. 2015

BIOMED PAP

View full text Add to dashboard Cite

Background. Around 20-40% of heart transplant patients experience moderate to severe rejection within the first year after heart transplantation. Endomyocardial biopsy (EMB) is a gold standard for diagnosing heart transplant rejection. There is a need for non-invasive alternatives that allow for early, safe and reliable diagnosis of acute graft rejection prior to the onset of clinical symptoms. Aims. Our aim was to investigate the potential of speckle tracking derived strain analysis in the diagnosis of acute graft rejection. Methods. Patients indicated for EMB consented to a trans-thoracic echocardiography examination (TTE) within 2 hours of the EMB. Of this cohort, those with at least 2 EMBs separated ≥ 1 week, and whose TTE could be analyzed for strain, were included. The relationship between strain and EMB results was evaluated. Results. Of the 43 patients included (mean age 51.33±1.79, 67% male), 23 had findings of rejection identified on at least one EMB and at least one EMB without rejection for comparison. A significant deterioration in the longitudinal strain during rejection compared to non-rejection was found on apical 4-chamber views (-11.51±0.91 vs -13.48±0.96, P=0.025) and apical 2-chamber views (-11.84±0.78 vs -14.43±0.83, P=0.002). In the patients in whom no rejection was identified on either EBM, there was no significant change in longitudinal strain values at two different time points. Conclusion. Worsening of longitudinal strain was associated with acute cellular rejection. Routine TTE-based strain analysis could help in early detection of cardiac rejection and timing of EMB.

show abstract

“…The initial procedure, completed three days prior to diagnosis, was EMB, a routine procedure indicated after OHT to monitor for rejection. Cardiac perforation is a known, rare complication, with a reported incidence of 0-0.3% [1][2][3][4][5], but only one actual case of ventricular hematoma has been described, and this was a unique case of septal hematoma [6]. A single-lead pacemaker was placed in the RV two days prior to diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Ventricular Hematoma after Heart Transplant and Repeated Myocardial Instrumentation

Belkin¹,

Chung²,

Uriel³

2017

J Clin Exp Cardiolog

View full text Add to dashboard Cite

A 69 year-old male Jehovah's Witness with a past medical history of non-ischemic cardiomyopathy, coronary artery disease (CAD), obesity, gout, and nephrolithiasis presented to a large academic medical center for evaluation for advanced options. He had a myocardial infarction in 2004, requiring a single stent to the left anterior descending artery. He was found to have an ejection fraction of 10% that was thought to be out-of-proportion to his CAD. His cardiac function did not improve with guideline-directed medical therapy, including a biventricular implantable cardioverter-defibrillator, and on presentation he was no longer able to tolerate significant neurohormonal blockade. Of note, family history was notable for a mother with a "large heart, " but the rest of his history was non-contributory. The patient was deemed a good candidate for advanced options, and he subsequently underwent bloodless orthotopic heart transplant (OHT) in June 2016.Initial post-operative transthoracic echocardiogram (TTE) showed a moderate pericardial effusion without hemodynamic compromise. Three weeks post-OHT, the patient developed various atrial arrhythmias, including blocked premature atrial contractions resulting in bradycardia and concerning for rejection. He underwent endomyocardial biopsy (EMB) which showed grade 0 rejection. The next day, a permanent pacemaker was implanted with the single right ventricular (RV) lead placed in the apical, septal region with active fixation. The following day, the temporary epicardial pacing leads were removed at bedside; removal of the second RV lead was complicated by resistance and induction of premature ventricular contractions. The next day, TTE was notable for hematoma in the myocardium of the RV and the apicolateral segment of the left ventricle (LV). Because of this finding, future monitoring for rejection was performed with TTE, and biopsy deferred for 4 weeks. On repeat TTE ten days later, the hematoma had resolved, and the patient had good graft function. Repeat EMB four weeks after the initial diagnosis of hematoma remained Grade 0.The patient has continued to have good cardiac function, without evidence of complication from the intraventricular hematoma, and he has not had any significant rejection in the first eleven months following OHT.

show abstract

Complications of Endomyocardial Biopsy in Heart Transplant Patients: A Retrospective Study of 2117 Consecutive Procedures

Cited by 97 publications

References 24 publications

Randomized Pilot Trial of Gene Expression Profiling Versus Heart Biopsy in the First Year After Heart Transplant

Randomized Pilot Trial of Gene Expression Profiling Versus Heart Biopsy in the First Year After Heart Transplant

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Diffuse Ventricular Hematoma after Heart Transplant and Repeated Myocardial Instrumentation

Contact Info

Product

Resources

About