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Safety and Diagnostic Yield of Endomyocardial Biopsy: A Single-Centre Experience
Session:
Sessão de Comunicações Orais 01 – Dentro do Laboratório de Hemodinâmica: estratégias contemporâneas e resultados na vida real
Speaker:
Mafalda de Oliveira Griné
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mafalda Oliveira Grine; Gonçalo Abel; Tânia Camacho; Fátima Saraiva; João Borges-Rosa; Manuel Oliveira-Santos; Vítor Matos; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Introduction: </span></strong><span style="font-family:"Times New Roman",serif">Endomyocardial biopsy (EMB) remains the reference standard for diagnosing myocardial disorders and monitoring cardiac allograft rejection, yet its clinical value must be continually weighed against procedural risks. Contemporary data from large, real-world cohorts are limited. We sought to evaluate the diagnostic yield, procedural success, and safety profile of EMB at our centre over the last two decades.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Methods: </span></strong><span style="font-family:"Times New Roman",serif">We retrospectively reviewed all EMBs performed between November 2003 and August 2025. Demographic and clinical characteristics, procedural details, and histopathological results were extracted from electronic health records. Procedures with insufficient documentation were excluded. Procedural success was defined as completion of EMB via the intended access route with adequate sample number and quality. Diagnostic yield was defined as the proportion of procedures yielding a clinically meaningful diagnosis.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Results: </span></strong><span style="font-family:"Times New Roman",serif">A total of 3303 EMBs yielding 6544 specimens (mean 2 fragments/procedure) were analysed. The predominant indication was cardiac allograft rejection surveillance (n=3252; 98%). Transfemoral access was used in 97% of procedures. Procedural failure was rare (32 cases; 0.97%), most commonly due to retrieval of fibrous tissue, likely representing prior biopsy scarring (valvular tissue, fat and thrombi were less frequent).<strong> </strong>Among EMBs performed for rejection surveillance, 99% were diagnostic (90% grade 0R; 8% grade 1R; 2% grade 2R; 0.47% grade 3R, ISHLT 2005 criteria). Of the 50 EMBs performed for non-transplant related indications, 36 (72%) yielded an etiologic diagnosis.<strong> </strong>Complications were infrequent (29 events; 0.88%) and predominantly minor: vasovagal episodes (n=4), access-site hematomas (n=2) and one femoral pseudoaneurysm successfully treated with thrombin injection. Arrhythmic complications included atrial fibrillation (n=1), atrial flutter requiring cardioversion (n=1), transient AV conduction disturbances (n=3) and one episode of ventricular tachycardia promptly treated with propranolol. Fourteen small coronary artery fistulas were identified, none requiring intervention. Two cases of cardiac perforation with tamponade required drainage, both with full recovery. No other major complications such as severe valvular injury, stroke, pneumothorax, venous thromboembolism, major bleeding or death were observed.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Conclusions: </span></strong><span style="font-family:"Times New Roman",serif">In this large, single-centre cohort, EMB demonstrated a high procedural success rate and a low rate of complications. These findings support EMB as a safe and valuable tool, particularly for guiding postoperative management of heart transplant recipients. In our cohort, the rejection rate was low, with most EMBs classified as grade 0R according to ISHLT 2005 criteria.</span></span></span></span></p>
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