Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: results of a multicenter experience.
Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: results of a multicenter experience.
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DOI：
10.1016/j.healun.2011.11.019
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发表时间：
2012-04
期刊：
影响因子：
--
通讯作者：
Bergersen L
中科院分区：
文献类型：
--
作者：
Daly KP;Marshall AC;Vincent JA;Zuckerman WA;Hoffman TM;Canter CE;Blume ED;Bergersen L
先前没有记录心脏移植受者心导管插入术和心内膜心肌活检 (EMB) 的安全性和诊断率的报告包含多中心数据。有关在心脏移植受者中进行的 EMB 手术的安全性和诊断率的数据记录在 8 个儿科中心的先天性心导管插入结果项目数据库中，历时 3 年。不良事件 (AE) 根据 5 级严重程度进行分类。广义估计方程模型确定了高严重性不良事件 (HSAE)（3-5 级）和非诊断性活检样本的风险因素。 744 名儿童心脏移植受者（中位年龄 12 岁 [IQR：4.8,16.7]，54% 为男性）总共进行了 2665 例 EMB 病例。 AE 发生 88 例（3.3%），其中 28 例（1.1%）为 HSAE。 EMB 引起的 AE 包括三尖瓣损伤、短暂性完全性心脏传导阻滞和 RBBB。在 822 例涉及冠状动脉造影的病例中，10 例（1.2%）导致冠状动脉相关 AE。没有发生心肌穿孔或死亡。 HSAE 的多变量危险因素包括先前导管插入次数较少 (p=0.006) 和较长的病例长度 (p=<0.001)。 EMB 为 99% 的病例提供了足够的组织用于诊断。心脏移植后的较长时间是非诊断性活检样本的最显着预测因素 (p<0.001)。在当今时代，涉及 EMB 的心导管检查可以在儿科心脏移植受者中进行，AE 发生率低，诊断率高。移植后早期活检和病例长度较长时，HSAE 的风险会增加。心脏移植后时间较长与非诊断性 EMB 样本相关。
No prior reports documenting the safety and diagnostic yield of cardiac catheterization and endomyocardial biopsy (EMB) in heart transplant recipients include multicenter data. Data on the safety and diagnostic yield of EMB procedures performed in heart transplant recipients were recorded in the Congenital Cardiac Catheterization Outcomes Project database at 8 pediatric centers over a 3 year period. Adverse events (AE) were classified according to a 5 level severity scale. Generalized estimating equation models identified risk factors for high severity adverse events (HSAE) (Levels 3-5) and non-diagnostic biopsy samples. A total of 2665 EMB cases were performed in 744 pediatric heart transplant recipients (median age 12 years [IQR: 4.8,16.7] and 54% male). AE occurred in 88 cases (3.3%), of which 28 (1.1%) were HSAE. AE attributable to EMB included tricuspid valve injury, transient complete heart block, and RBBB. Amongst 822 cases involving coronary angiography, 10 (1.2%) resulted in a coronary related AE. There were no myocardial perforations or deaths. Multivariable risk factors for HSAE included fewer prior catheterizations (p=0.006) and longer case length (p=<0.001). EMB yielded sufficient tissue for diagnosis in 99% of cases. Longer time since heart transplant was the most significant predictor of a non-diagnostic biopsy sample (p<0.001). In the current era, cardiac catheterizations involving EMB can be performed in pediatric heart transplant recipients with a low AE rate and high diagnostic yield. Risk of HSAE is increased in early post-transplant biopsies and with longer case length. Longer time since heart transplant is associated with non-diagnostic EMB sample.
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