{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:38:37Z","timestamp":1790192317009,"version":"4.1.0"},"reference-count":51,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Endomyocardial biopsy (EMB) is considered the gold standard for monitoring allograft rejection after heart transplantation. EMB is an invasive procedure that may be performed via a trans-jugular or a trans-femoral approach with a complication rate reported as less than 6%. The aim of this study was to evaluate the complication rate after EMBs in heart recipients and to compare the results of EMBs performed via a trans-jugular or a trans-femoral approach. Methods: Medical records of heart recipients undergoing EMBs between January 2012 and December 2022 were retrospectively reviewed. EMB-related complications were classified as major (death, pericardial effusion, hemopericardium, cardiac tamponade requiring a pericardiocentesis or an urgent cardiac surgery, ventricular arrythmias, permanent atrio-ventricular block requiring permanent pacing, hemothorax, pneumothorax and retroperitoneal bleeding) and minor (de novo tricuspid regurgitation, arrhythmias, coronary artery fistula, vascular access site complications). Results: A total of 1698 EMBs were performed during the study period at our institution in 212 heart recipients. There were 927 (55%) EMBs performed through a trans-jugular approach (TJ group) and 771 (45%) EMBs performed through a trans-femoral approach (TF group). A total of 60 (3.5%) complications were recorded, including nine (0.5%) major complications (six cardiac tamponades, two pneumothorax and one retroperitoneal bleeding) and 51 (3%) minor complications (seven coronary fistulae, five de novo tricuspid regurgitation, four supraventricular arrythmias and thirty-five vascular access site complications). No difference was found in total (38 [4%] vs. 22 [3%]; p = 0.16) and major (6 [1%} vs. 3 [0.4%]; p = 0.65) complications (32 [3%] vs. 19 [2%]; p = 0.23) between the TJ group and the TF group. No difference was found in male sex, age at time of EMB and time from HT between complicated and not complicated EMBs. Conclusions: EMBs represent a safe procedure with a low risk of complications. In our experience, EMBs performed via a trans-jugular approach are as safe as the trans-femoral approach.<\/jats:p>","DOI":"10.3390\/jcdd11040115","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T08:42:34Z","timestamp":1712133754000},"page":"115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Ten-Year Experience with Endomyocardial Biopsy after Orthotopic Heart Transplantation: Comparison between Trans-Jugular and Trans-Femoral Approach"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5965-6571","authenticated-orcid":false,"given":"Antonella","family":"Galeone","sequence":"first","affiliation":[{"name":"Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Bernabei","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Pesarini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Raimondi Lucchetti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0879-3557","authenticated-orcid":false,"given":"Francesco","family":"Onorati","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Battista","family":"Luciani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1111\/tri.12298","article-title":"Clinical outcome and quality of life of patients surviving 20 years or longer after heart transplantation","volume":"27","author":"Galeone","year":"2014","journal-title":"Transpl. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.healun.2015.08.003","article-title":"The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report\u20132015; Focus Theme: Early Graft Failure","volume":"34","author":"Lund","year":"2015","journal-title":"J. Heart Lung Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.healun.2014.08.003","article-title":"The registry of the International Society for Heart and Lung Transplantation: Thirty-first official adult heart transplant report\u20142014; focus theme: Retransplantation","volume":"33","author":"Lund","year":"2014","journal-title":"J. Heart Lung Transplant."},{"key":"ref_4","first-page":"213","article-title":"Needle biopsy of the human ventricular myocardium","volume":"30","author":"Kent","year":"1956","journal-title":"Q. Bull. Northwestern Univ. Med. Sch."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1536\/ihj.3.537","article-title":"Endomyocardial biopsy","volume":"3","author":"Sakakibara","year":"1962","journal-title":"JPN Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1001\/jama.1973.03220300044010","article-title":"Percutaneous Transvenous Endomyocardial Biopsy","volume":"225","author":"Caves","year":"1973","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/0002-9149(84)90414-4","article-title":"The femoral venous approach to endomyocardial biopsy: Comparison with internal jugular and transarterial approaches","volume":"53","author":"Anderson","year":"1984","journal-title":"Am. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.healun.2005.03.019","article-title":"Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection","volume":"24","author":"Stewart","year":"2005","journal-title":"J. Heart Lung Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1097\/TP.0b013e31826e19e2","article-title":"Concordance among pathologists in the second Cardiac Allograft Rejection Gene Expression Observational Study (CARGO II)","volume":"94","author":"Zuckermann","year":"2012","journal-title":"Transplantation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/ejhf.2190","article-title":"Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society position statement on endomyocardial biopsy","volume":"23","author":"Seferovic","year":"2021","journal-title":"Eur. J. Heart Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.healun.2010.05.034","article-title":"The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients","volume":"29","author":"Costanzo","year":"2010","journal-title":"J Heart Lung Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1161\/CIRCULATIONAHA.109.924167","article-title":"Comparative evaluation of left and right ventricular endomyocardial biopsy: Differences in complication rate and diagnostic performance","volume":"122","author":"Yilmaz","year":"2010","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1161\/CIRCULATIONAHA.107.743427","article-title":"Complication rate of right ventricular endomyocardial biopsy via the femoral approach: A retrospective and prospective study analyzing 3048 diagnostic procedures over an 11-year period","volume":"118","author":"Holzmann","year":"2008","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2216","DOI":"10.1161\/CIRCULATIONAHA.107.186093","article-title":"The role of endomyocardial biopsy in the management of cardiovascular disease: A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology","volume":"116","author":"Cooper","year":"2007","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1159\/000493786","article-title":"National trends and procedural complications from endomyocardial biopsy: Results from the National Inpatient Sample, 2007-2014","volume":"141","author":"Shah","year":"2018","journal-title":"Cardiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.jchf.2022.08.005","article-title":"Safety of Right and Left Ventricular Endomyocardial Biopsy in Heart Transplantation and Cardiomyopathy Patients","volume":"10","author":"Bermpeis","year":"2022","journal-title":"JACC Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1016\/j.transproceed.2023.08.016","article-title":"Cost and Use Trends of Endomyocardial Biopsy in Heart Transplant Patients: A 4-Year Claims Data Analysis","volume":"55","author":"Vilalta","year":"2023","journal-title":"Transplant. Proc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1016\/j.transproceed.2012.07.024","article-title":"Tricuspid valve injury after heart transplantation due to endomyocardial biopsy: An analysis of 3550 biopsies","volume":"44","author":"Fiorelli","year":"2012","journal-title":"Transplant. Proc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.healun.2004.11.007","article-title":"Tricuspid valve chordal tissue in endomyocardial biopsy specimens of patients with significant tricuspid regurgitation","volume":"24","author":"Mielniczuk","year":"2005","journal-title":"J. Heart Lung Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.healun.2007.12.011","article-title":"Tricuspid regurgitation after cardiac transplantation: An old problem revisited","volume":"27","author":"Wong","year":"2008","journal-title":"J. Heart Lung Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S1053-2498(01)00258-3","article-title":"Severe tricuspid regurgitation after heart transplantation","volume":"20","author":"Chan","year":"2001","journal-title":"J. Heart Lung Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.healun.2005.09.013","article-title":"Optimal surgical management of severe tricuspid regurgitation in cardiac transplant patients","volume":"25","author":"Filsoufi","year":"2006","journal-title":"J. Heart Lung Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S227","DOI":"10.1016\/j.healun.2004.07.007","article-title":"Tricuspid regurgitation after cardiac transplantation: How many biopsies are too many?","volume":"24","author":"Nguyen","year":"2005","journal-title":"J. Heart Lung Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.jcin.2021.02.044","article-title":"Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure","volume":"14","author":"AlKhouli","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.transproceed.2011.03.010","article-title":"Complications of endomyocardial biopsy in heart transplant recipients: A retrospective study of 2117 consecutive procedures","volume":"43","author":"Saraiva","year":"2011","journal-title":"Transplant. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S0009-9260(05)80664-6","article-title":"Coronary cameral fistulae following heart transplantation","volume":"44","author":"Somers","year":"1991","journal-title":"Clin. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/0735-1097(89)90083-1","article-title":"Coronary artery to right ventricle fistula in heart transplant recipients: A complication of endomyocardial biopsy","volume":"14","author":"Henzlova","year":"1989","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1161\/01.CIR.79.2.350","article-title":"Coronary artery fistula in the heart transplant patient: A potential complication of endomyocardial biopsy","volume":"79","author":"Sandhu","year":"1989","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1002\/clc.22368","article-title":"Hospital volume and cardiac complications of endomyocardial biopsy: A retrospective cohort study of 9508 adult patients using a nationwide inpatient database in Japan","volume":"38","author":"Isogai","year":"2015","journal-title":"Clin. Cardiol."},{"key":"ref_30","unstructured":"ACS Committee on Perioperative Care (2011). Revised statement on recommendations for use of real-time ultrasound guidance for placement of central venous catheters. Bull. Am. Coll. Surg., 96, 36\u201337."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1186\/s13054-017-1814-y","article-title":"Ultrasound-guided central venous catheter placement: A structured review and recommendations for clinical practice","volume":"21","author":"Saugel","year":"2017","journal-title":"Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Cusi, V., Vaida, F., Wettersten, N., Rodgers, N., Tada, Y., Gerding, B., Urey, M.A., Greenberg, B., Adler, E.D., and Kim, P.J. (Transplantation, 2023). Incidence of Acute Rejection Compared with Endomyocardial Biopsy Complications for Heart Transplant Patients in the Contemporary Era, Transplantation, Online ahead of print.","DOI":"10.1097\/TP.0000000000004882"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Pergola, V., Mattesi, G., Cozza, E., Pradegan, N., Tessari, C., Dellino, C.M., Savo, M.T., Amato, F., Cecere, A., and Perazzolo Marra, M. (2023). New Non-Invasive Imaging Technologies in Cardiac Transplant Follow-Up: Acquired Evidence and Future Options. Diagnostics, 13.","DOI":"10.20944\/preprints202306.2206.v1"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12968-018-0480-9","article-title":"Cardiovascular magnetic resonance in heart transplant patients: Diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis","volume":"20","author":"Vermes","year":"2018","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1161\/CIRCULATIONAHA.121.057006","article-title":"Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation","volume":"145","author":"Anthony","year":"2022","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Brunetti, G., Barile, B., Nicchia, G.P., Onorati, F., Luciani, G.B., and Galeone, A. (2023). The ST2\/IL-33 Pathway in Adult and Paediatric Heart Disease and Transplantation. Biomedicines, 11.","DOI":"10.3390\/biomedicines11061676"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e14616","DOI":"10.1111\/ctr.14616","article-title":"Suppression of tumorigenicity-2 (ST2) is a promising biomarker in heart transplantation","volume":"36","author":"Galeone","year":"2022","journal-title":"Clin. Transplant."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1016\/j.athoracsur.2011.07.048","article-title":"Soluble ST2 is a marker for acute cardiac allograft rejection","volume":"92","author":"Garrido","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"250","DOI":"10.3109\/1354750X.2013.773081","article-title":"Interleukin receptor family member ST2 concentrations in patients following heart transplantation","volume":"18","author":"Januzzi","year":"2013","journal-title":"Biomarkers"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Coutance, G., Desir\u00e9, E., and Duong Van Huyen, J.-P. (2022). A Review of Biomarkers of Cardiac Allograft Rejection: Toward an Integrated Diagnosis of Rejection. Biomolecules, 12.","DOI":"10.3390\/biom12081135"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.healun.2017.12.008","article-title":"Utility of Troponin Assays for Exclusion of Acute Cellular Rejection after Heart Transplantation: A Systematic Review","volume":"37","author":"Fitzsimons","year":"2018","journal-title":"J. Heart Lung Transplant."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1161\/CIRCULATIONAHA.120.049098","article-title":"Cell-Free DNA to Detect Heart Allograft Acute Rejection","volume":"143","author":"Shah","year":"2021","journal-title":"Circulation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.ajt.2023.02.025","article-title":"The evolving use of biomarkers in heart transplantation: Consensus of an expert panel","volume":"23","author":"Kobashigawa","year":"2023","journal-title":"Am. J. Transplant."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients","volume":"42","author":"Velleca","year":"2023","journal-title":"J. Heart Lung Transplant."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1600-6143.2005.01175.x","article-title":"Noninvasive Discrimination of Rejection in Cardiac Allograft Recipients Using Gene Expression Profiling","volume":"6","author":"Deng","year":"2006","journal-title":"Am. J. Transplant."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1056\/NEJMoa0912965","article-title":"Gene-Expression Profiling for Rejection Surveillance after Cardiac Transplantation","volume":"362","author":"Pham","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1161\/CIRCHEARTFAILURE.114.001658","article-title":"Randomized Pilot Trial of Gene Expression Profiling versus Heart Biopsy in the First Year after Heart Transplant: Early Invasive Monitoring Attenuation through Gene Expression Trial","volume":"8","author":"Kobashigawa","year":"2015","journal-title":"Circ. Heart Fail."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1093\/eurheartj\/ehv682","article-title":"Clinical Usefulness of Gene-Expression Profile to Rule out Acute Rejection after Heart Transplantation: CARGO II","volume":"37","author":"Stypmann","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"6058","DOI":"10.7150\/thno.56327","article-title":"MicroRNAs as Theranostic Markers in Cardiac Allograft Transplantation: From Murine Models to Clinical Practice","volume":"11","year":"2021","journal-title":"Theranostics"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"8029","DOI":"10.1038\/s41598-020-64900-w","article-title":"Myocardial micro-biopsy procedure for molecular characterization with increased precision and reduced trauma","volume":"10","author":"Grankvist","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.healun.2017.05.029","article-title":"Building a tissue-based molecular diagnostic system in heart transplant rejection: The heart Molecular Microscope Diagnostic (MMDx) System","volume":"36","author":"Halloran","year":"2017","journal-title":"J. Heart Lung Transplant."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/4\/115\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:23:02Z","timestamp":1760106182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/4\/115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,3]]},"references-count":51,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcdd11040115"],"URL":"https:\/\/doi.org\/10.3390\/jcdd11040115","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,3]]}}}