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

Tawfiq Choudhury
Tawfiq Choudhury1, MBBS, MD (Res); Philipp Lurz2, MD; Tim G. Schäufele3, MD; Miguel Nobre Menezes4, MD; Shahar Lavi1, MD, FRCP, FACC; Nikolaos Tzemos1, MD; Philipp Hartung2, MD; Thomas Stiermaier5, MD; Katsutoshi Makino6, MD; Olivier F. Bertrand7, MD, PhD; Ian C. Gilchrist8, MD, FACC; Mamas A. Mamas9, BM, BCh, DPhil; Rodrigo Bagur1,9,10, MD, PhD, FAHA
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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