B-12 | Safety, Feasibility and Outcomes of Echocardiogram-guided Endomyocardial Biopsies in Pediatric Heart Transplant Patients

Fluoroscopic-guided endomyocardial biopsy is the gold standard for monitoring cardiac transplant rejection. Procedural risks include fluoroscopy time, perforation of the right ventricular free wall, and development or worsening of tricuspid regurgitation (TR). Some centers are moving toward echocardiography-guided biopsy to reduce radiation exposure and procedural risks. Here, we will retrospectively study the safety and outcomes of echocardiography-guided biopsy at our center. We analyzed 68 patients who were transplanted at our tertiary care center from 2010-2018. A total of 818 biopsies were performed with fluoroscopic (n=309, 42.1%) or combined fluoroscopic and echocardiographic guidance (n=424, 57.8%). Groups were stratified by right (R) and right/left heart (R/L) catheterization in addition to bioptome guidance method. The echocardiography-only group had longer fluoroscopy time (R=8.29 [95%CI: 7.18-9.41], R/L=15.75 [95%CI: 14.26-17.23]) than the fluoroscopic-only groups (R=6.43 [95%CI: 5.03-7.83], R/L=10.61 [95%CI: 8.93-12.28]) (Figure 1). Wilcoxon signed-rank test demonstrated no significant TR worsening in the fluoroscopy or the echocardiography-only group after catheterization and biopsy. No right ventricular free wall perforations were observed in either group. Preliminary data shows a greater fluoroscopy time in the echo-guided group. TR worsening does not significantly differ between groups. Ongoing work will further stratify the data by complexity of cardiac anatomy and whether other procedures (i.e. stent or device placement) were performed.