Complication Rate of Right Ventricular Endomyocardial Biopsy via the Femoral Approach A Retrospective and Prospective Study Analyzing 3048 Diagnostic Procedures Over an 11-Year Period
Complication Rate of Right Ventricular Endomyocardial Biopsy via the Femoral Approach A Retrospective and Prospective Study Analyzing 3048 Diagnostic Procedures Over an 11-Year Period
复制标题
DOI：
10.1161/circulationaha.107.743427
复制
发表时间：
2008-10-21
期刊：
影响因子：
37.8
通讯作者：
Pauschinger, Matthias
中科院分区：
文献类型：
--
作者：
Holzmann, Matthias;Nicko, Alexander;Pauschinger, Matthias
背景-心肌炎和心脏病毒持续性的明确诊断是基于心内膜心肌活检(EMBS)的组织学、免疫组织学和分子生物学分析。基于活检的心肌炎诊断变得越来越重要，因为最近的研究证明了基于活检的因果治疗策略(免疫抑制或抗病毒)的有益效果。由于EMB手术引起的主要并发症的风险尚未明确，在这项回顾和前瞻性的单中心研究中，我们评估了右室EMB手术的主要并发症和轻微并发症的发生率。方法和结果：使用改良的Cordis活组织刀，1919例患者在9年内(1995年1月至2003年12月)进行了2505次EMB手术，其中496例患者在2004年1月至2005年12月期间前瞻性地接受了543次EMB手术。共有2415名患者在双平面透视控制下接受了3048例右股静脉途径的EMB手术，以评估排除继发性原因后原因不明的左心功能不全(回顾的左心室射血分数，49.8+/-18.8%；预期的，48.8+/-19.7%)。在每一次EMB手术中，平均获得8.2+/-0.8个eMB，前瞻性获得10.1+/-0.6个标本，共26025个标本。没有患者死亡或需要紧急心脏手术。其他主要并发症，如需要心包穿刺术的心脏压塞或需要永久起搏的完全性房室传导阻滞非常罕见：回顾研究中0.12%，前瞻性研究中为0%。在回顾研究和前瞻性研究中，0.20%的EMB手术发生了轻微的并发症，如心包积液、传导异常或心律失常。结论：在有经验的操作人员的指导下，经股静脉途径进行EMB手术的并发症发生率很低。(发行量。2008；118：1722-1728。)
Background-An unequivocal diagnosis of myocarditis and cardiac virus persistence is based on histological, immunohistological, and molecular biological analyses of endomyocardial biopsies (EMBs). Biopsy-based diagnosis of myocarditis has become increasingly important because recent studies have demonstrated the beneficial effects of biopsy-based causal treatment strategies (immunosuppressive or antiviral). Because the risks of major complications caused by EMB procedures have not yet been well defined, we evaluated the incidence of major and minor complications of right ventricular EMB procedures in this retrospective and prospective single-center study.Methods and Results-With the use of a modified Cordis bioptome, 1919 patients underwent 2505 EMB procedures retrospectively over a 9-year period (January 1995 to December 2003), and 496 patients underwent 543 EMB procedures prospectively between January 2004 and December 2005. A total of 2415 patients had 3048 EMB procedures via the right femoral vein approach under biplane fluoroscopic control to evaluate unexplained left ventricular dysfunction (retrospective left ventricular ejection fraction, 49.8 +/- 18.8%; prospective, 48.8 +/- 19.7%) after exclusion of secondary causes. During each EMB procedure, an average of 8.2 +/- 0.8 EMBs were obtained retrospectively and 10.1 +/- 0.6 specimens prospectively for a total of 26 025 specimens. No patient died or required emergency cardiac surgery. Other major complications like cardiac tamponade requiring pericardiocentesis or complete atrioventricular block requiring permanent pacing were very rare: 0.12% in the retrospective study and 0% in the prospective study. Minor complications such as pericardial effusion, conduction abnormalities, or arrhythmias occurred in 0.20% of the EMB procedures in the retrospective study and 5.5% in the prospective study.Conclusions-The EMB procedure via the femoral vein approach under fluoroscopic guidance has a very low complication rate when performed by experienced operators. (Circulation. 2008; 118: 1722-1728.)