Validation of A New Femoral Venous Method of Endomyocardial Biopsy. Comparison with Internal Jugular Approach

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Abstract
Endomyocardial biopsy is a reliable and reproducible technique to confirm or establish a clinical diagnosis in many cases of idiopathic heart muscle disease. Our overall experience of 243 consecutive nontransplant related biopsy procedures (combined experience of previously reported and current series) comparing a new femoral venous (n = 94) with a standard internal jugular venous (n = 149) approach is reviewed. In the current series, the femoral (n = 59) and the internal jugular (n = 80) approaches, performed on 139 consecutive nontransplant‐related procedures (466 myocardial samples), were compared. Vascular access was achieved in all femoral procedures; the internal jugular vein could not be located in 4% (three) of neck approaches (P = NS). Myocardial sampling was sufficient in all internal jugular procedures; sampling was adequate in all femoral procedures except two (3%, P = NS). Two cases of hematoma were observed after an internal jugular approach. Pericardial effusion was observed in one patient after femoral and in one patient after internal jugular approaches (P = NS), and in the latter case, tamponade developed requiring intervention. Transient atrioventricular block (complete in 2 and 2:1 in 1) developed in three patients (femoral procedures), but all of these patients had shown predisposing complete left bundle branch block on their electrocardiogram. No difference in vascular access, sampling efficiency and complication rate between our previous and current series regarding the internal jugular and femoral approaches was observed. Our overall experience with the femoral and internal jugular approaches was similar for complication rate (1% in both). Vascular access was better overall with the femoral approach (100% vs 93%, P <0. 01), reflecting more difficulty with internal jugular access in the first series. Thus, the femoral venous approach described is comparable in efficacy and safety to the standard internal jugular approach and may be especially useful as an alternative to right ventricular biopsy when the internal jugular vein cannot be successfully cannulated or when a cardiac catheterization from the femoral area is being performed at the same time for other reasons.