TRANSRADIAL VERSUS TRANSFEMORAL APPROACH FOR LEFT VENTRICULAR ENDOMYOCARDIAL BIOPSY

Abstract

The diagnostic yield of left ventricular endomyocardial biopsy (LV-EMB) is superior to right ventricular endomyocardial biopsy (RV-EMB) in conditions where the pathology predominantly involves the left ventricle. LV-EMB is most frequently performed via the transfemoral (TF) approach. Although transradial approach has achieved widespread use in coronary interventions, LV-EMB via transradial (TR) arterial access has only been reported in case reports and series, where it appears to be safe and feasible. The aim of this study is to compare the safety and feasibility of TR versus TF for LV-EMB in a multi-centre registry. This analysis includes retrospective data on patients who underwent LV-EMB in Canada, Germany, Japan, and Portugal. Clinical characteristics, procedural, safety and feasibility data were evaluated and compared between the two groups. LV-EMB was successfully performed through the TR approach in 113 out of 114 (99.1%) patients and 134 (100%) through the TF access. Patients in the TR group were older (mean age 56.5 versus 44.4 years, P<0.001), more likely to be in NYHA III/IV (TR 57% versus TF 31%, P<0.001) and to have moderate-severe mitral regurgitation (TR 28% versus TF 0%, P<0.001). The mean guide catheter size was significantly larger in the TF group (TF 8-Fr versus TR 7.1-Fr, P<0.001). Sheathless guides were used in 92 (81%) patients in the TR group and 2 (1.5%) patients in TF group. Mild or moderate radial artery spasm occurred in 13 (11.4%) patients but only one (0.88%) patient required conversion to femoral access due to severe spasm. No access site related complications were reported in the TR group while 11 (8.2%) patients in the TF group had access site hematomas (P=0.002). Of the latter, 9 (6.7%) had grade 2 and two (1.5%) had grade 1 hematomas. There were no major complications (pericardial tamponade, life-threatening arrhythmia, embolization or death) in either the TR or TF group. TR and TF approaches for LV-EMB are both associated with high procedural success rate. However, the TR group compares favourably with regards to access-site related complications. Randomised studies may help determine whether the TR approach translates to superior safety outcomes as compared to TF access for LV-EMB. Meanwhile, the results of this large multicentre study support the TR approach for LV-EMB and further encourage its utilization and expansion in the field of interventional cardiology.