The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Interventions for valvular disease and heart failure

Radial versus femoral approach for left ventricular endomyocardial biopsy

EuroIntervention 2019;15:678-684. DOI: 10.4244/EIJ-D-18-01061

1. London Health Sciences Centre, London, Ontario, Canada; 2. Heart Center Leipzig at University of Leipzig, Department of Internal Medicine-Cardiology, Leipzig, Germany; 3. Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; 4. Department of Cardiology, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, and CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; 5. University Heart Center of Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany; 6. Mie Prefectural General Medical Center, Yokkaichi, Japan; 7. Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada; 8. Pennsylvania State University, College of Medicine, Heart & Vascular Institute, Hershey, PA, USA; 9. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; 10. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada

Aims: Despite the widespread use of the radial approach in coronary interventions, left ventricular endomyocardial biopsy (LV-EMB) is most frequently performed via the femoral artery. We sought to assess the feasibility and safety of radial compared to femoral access in a large cohort of patients undergoing LV-EMB.

Methods and results: Data from 264 patients who underwent LV-EMB in Germany, Portugal, Japan and Canada were collected. Clinical, procedural, safety and feasibility data were evaluated and compared between the two groups. LV-EMB was successfully performed by the radial approach in 129 (99%) of 130 and in 134 (100%) patients by the femoral access. Patients in the radial group were older (mean age 55.7 versus 44.3 years) and were more likely to have moderate-severe mitral regurgitation (27.7% versus TF 0%). Sheathless guides were used in 108 (83.1%) of the radial and 2 (1.5%) of the femoral patients, so the mean guiding catheter size (radial 7.0±1.0 Fr versus femoral 8.0±0.0 Fr) was significantly smaller in the radial group (p<0.001). Mild or moderate radial artery spasm occurred in 13 (10.0%) patients but only one (0.8%) patient required conversion to femoral access due to severe spasm. No access site-related complications were reported in the radial group, while 11 (8.2%) patients in the femoral group had access-site haematomas (p=0.001). There were no major complications (mitral valve injury, pericardial tamponade requiring intervention, cerebrovascular accidents, persistent high-degree atrioventricular block, major bleeding or death) in either group.

Conclusions: The radial approach for LV-EMB appears to be safe and associated with a high success rate while possibly leading to fewer access-site bleeding complications compared to the femoral access. The results of this international multicentre study support the radial approach for LV-EMB and further inspire the expansion of “radial first” in the field of interventional cardiology.

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