The following is a summary of “Safety of Right and Left Ventricular Endomyocardial Biopsy in Heart Transplantation and Cardiomyopathy Patients” published in the December 2022 issue of Heart Failure by Bermpeis et al.

In both the patient’s own heart and the heart being donated, endomyocardial biopsy (EMB) allows for a histopathologic diagnosis with a specific prognosis and therapeutic implications. The overall complication rate is low and can vary from 1% to 6% based on the operator’s and patient’s experience, the patient’s health, the presence or absence of a left bundle branch block, the access site, and the location of the procurement (right ventricular [RV] vs left ventricular [LV] approach). The purpose of this research was to determine how frequently problems from the surgery actually occurred in a general population. EMBs were done for 2 main reasons: monitoring rejection episodes after a heart transplant, and determining the cause of cardiomyopathy.

In total, the scientists looked back at 1,368 biopsies taken from 561 individuals between May 2011 and May 2021. Patients were divided into groups based on factors, including their underlying cardiac disease, sex, age, access location, BMI, and whether they would have RV or LV surgery. Overall, the analysis found a complication rate of 4.1%. 1% or fewer of EMBs resulted in serious life-threatening cardiac problems, with tamponade requiring pericardiocentesis in 0.2% and urgent cardiac surgery in less than  0.1%. 

Overall, 3.3% of people experienced minor problems; these were more common during LV EMBs (3.9%) and when the native heart was sampled (5.3%) than in the general population (3.3%). LV and RV EMB for rejection surveillance after heart transplantation and cardiomyopathy diagnosis is a safe procedure with a low risk of consequences when performed by trained professionals. Complications with EMB were more common in individuals over 65, in female patients, and in those whose hearts were not transplanted.