Radial versus femoral approach for left ventricular endomyocardial biopsy

Abstract

Aims: Despite the widespread use of the radial approach in coronary interventions, left ventricular endomyocardial biopsy (LV-EMB) is most frequently performed via the femoral artery. We sought to assess the feasibility and safety of radial compared to femoral access in a large cohort of patients undergoing LV-EMB.Methods and results: Data from 264 patients who underwent LV-EMB in Germany, Portugal, Japan and Canada were collected. Clinical, procedural, safety and feasibility data were evaluated and compared between the two groups. LV-EMB was successfully performed by the radial approach in 129 (99%) of 130 and in 134 (100%) patients by the femoral access. Patients in the radial group were older (mean age 55.7 versus 44.3 years) and were more likely to have moderate-severe mitral regurgitation (27.7% versus TF 0%). Sheathless guides were used in 108 (83.1%) of the radial and 2 (1.5%) of the femoral patients, so the mean guiding catheter size (radial 7.0±1.0 Fr versus femoral 8.0±0.0 Fr) was significantly smaller in the radial group (p<0.001). Mild or moderate radial artery spasm occurred in 13 (10.0%) patients but only one (0.8%) patient required conversion to femoral access due to severe spasm. No access site-related complications were reported in the radial group, while 11 (8.2%) patients in the femoral group had access-site haematomas (p=0.001). There were no major complications (mitral valve injury, pericardial tamponade requiring intervention, cerebrovascular accidents, persistent high-degree atrioventricular block, major bleeding or death) in either group. Conclusions:The radial approach for LV-EMB appears to be safe and associated with a high success rate while possibly leading to fewer access-site bleeding complications compared to the femoral access. The results of this international multicentre study support the radial approach for LV-EMB and further inspire the expansion of "radial first" in the field of interventional cardiology.

Safety of transradial and transfemoral left ventricular compared with transfemoral right ventricular endomyocardial biopsy

“…A recently published study reported no major complications in conjunction with the transradial and transfemoral artery access but a spectrum of minor complications that was similar to that observed in our study 14 . Additionally, the authors provide evidence of a significantly higher prevalence of access site haematoma in patients undergoing transfemoral LV‐EMB compared with patients undergoing transradial LV‐EMB.…”

“…In the present study, we demonstrate a transradial artery access success of 99% (322 out of 323), which matches the success rates observed in the aforementioned study by Schäufele et al . (success rate of 98%) 12 and a study investigating the transradial approach compared with the transfemoral approach in a study population consisting of 264 patients (success rate also 99%) 14 . In both studies, the switch to the transfemoral access was mandatory in case of a severe spasm of the radial artery, whereas in our study, a dissection of the radial artery necessitated the switch to the transfemoral access site.…”

“…Establishing improved and sheathless guide catheters, LV‐EMB is nowadays feasible via the transradial access. To date, only a few small‐scale studies have reported about the safety 12,13 and non‐inferiority of the transradial procedure with regard to complications compared with the transfemoral access for LV‐EMB 14 . With the present study, we sought to analyse the safety of transradial LV‐EMB compared with both transfemoral LV‐EMB and transfemoral RV‐EMB in a large sample of 514 consecutive patients of an all‐comer population with HF of unknown aetiology.…”

Biópsia endomiocárdica. Efectuar sempre que necessário!

“…Trata‐se de um estudo observacional, com doentes selecionados, em que os autores demostram a segurança e eficácia da técnica num grupo de doentes com suspeita de miocardiopatia/miocardite, não incluindo doentes transplantados. Os bons resultados obtidos por via transradial estão em linha com outros estudos reportados na literatura 9 , 10 e a evolução do material disponível, bem como a experiência dos operadores em acesso radial, indicia um desejável crescimento do método. A realização simultânea de ecocardiograma parece ser um contributo importante para a segurança da técnica.…”

Endomyocardial biopsy. Do it whenever you need it!

“…The positive findings obtained via transradial access corroborate other reported studies 9 , 10 and developments in the material available and operators’ experience in radial access point to a desirable growth of the method. Performing anechocardiogram simultaneously appears to contribute significantly to the safety of the technique.…”