Endomyocardial biopsy in patients requiring VA-ECMO for new-onset acute heart failure had a higher rate of major complications than biopsies without VA-ECMO (26.1% vs 8.0% vs 3.7%, P=0.003).
Cohort (n=230)
Yes
Does endomyocardial biopsy while requiring VA-ECMO increase major complications compared to non-VA-ECMO biopsies in patients with new-onset acute heart failure?
Endomyocardial biopsy in patients on VA-ECMO for new-onset acute heart failure carries a high risk of major complications (26.1%) but yields a histopathologic diagnosis in the majority of cases (78.3%).
Absolute Event Rate: 26.1% vs 8%
p-value: p=0.003
Background: Endomyocardial biopsy (EMB) has an important role in determining the pathogenesis of new-onset acute heart failure (new-AHF) when noninvasive testing is impossible. However, data on safety and histopathologic outcomes in patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is lacking. Methods: A retrospective, multicenter cohort of patients undergoing EMB while requiring VA-ECMO for new-AHF between 1990 and 2020 was compared with a cohort of nontransplant related biopsies not requiring VA-ECMO. Primary end point of the study was to determine the safety of EMB. Additionally, we describe the underlying pathogenesis causing new-AHF based on histopathologic examination of the samples obtained. Results: A total of 23 patients underwent EMB while requiring VA-ECMO (10.0%), 125 (54.3%) during an unplanned admission, and 82 (35.7%) in elective setting. Major complications occurred in 8.3% of all procedures with a significantly higher rate in patients requiring VA-ECMO (26.1% versus 8.0% versus 3.7%, P =0.003) predominately due to the occurrence of sustained ventricular tachycardia or need of resuscitation (13.0% versus 3.2% versus 1.2%, P =0.02). EMB led to a histopathologic diagnosis in 78.3% of the patients requiring VA-ECMO which consisted primarily of patients with myocarditis (73.9%). Conclusions: EMB in patients requiring VA-ECMO can be performed albeit with a substantial risk of major complications. The risk of the procedure was offset by a histopathologic diagnosis in 78.3% of the patients, which for the majority consisted of patients with myocarditis. The important therapeutic and prognostic implications of establishing an underlying pathogenesis causing new-AHF in this population warrant further refinement to improve procedural safety.
Boon et al. (Sun,) conducted a cohort in New-onset acute heart failure (n=230). Endomyocardial biopsy while requiring VA-ECMO vs. Endomyocardial biopsy not requiring VA-ECMO was evaluated on Safety of EMB (major complications) (p=0.003). Endomyocardial biopsy in patients requiring VA-ECMO for new-onset acute heart failure had a higher rate of major complications than biopsies without VA-ECMO (26.1% vs 8.0% vs 3.7%, P=0.003).