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.

中文翻译：

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心内膜心肌活检在需要静脉-动脉体外膜氧合的新发急性心力衰竭中的安全性

背景：当无创检测无法进行时，心内膜心肌活检 (EMB) 在确定新发急性心力衰竭 (new-AHF) 的发病机制方面具有重要作用。然而，缺乏需要静脉-动脉体外膜肺氧合 (VA-ECMO) 的患者的安全性和组织病理学结果的数据。与一组不需要 VA-ECMO 的非移植相关活检相比。该研究的主要终点是确定 EMB 的安全性。此外，我们根据获得的样本的组织病理学检查描述了导致新 AHF 的潜在发病机制。结果：共有 23 名患者在需要 VA-ECMO 时接受了 EMB（10.0%），125 名（54.3%）在计划外入院期间，和 82 (35.7%) 在选修设置。所有手术中有 8.3% 发生严重并发症，需要 VA-ECMO 的患者发生率明显更高（26.1% 对 8.0% 对 3.7%，P = 0.003）主要是由于发生持续性室性心动过速或需要复苏（13.0% vs 3.2% vs 1.2%，P = 0.02）。EMB 导致 78.3% 需要 VA-ECMO 的患者获得组织病理学诊断，其中主要包括心肌炎患者（73.9%）。结论：需要 VA-ECMO 的患者可以进行 EMB，尽管存在重大并发症的风险。该手术的风险被 78.3% 的患者的组织病理学诊断所抵消，其中大多数为心肌炎患者。在该人群中建立导致新 AHF 的潜在发病机制的重要治疗和预后意义需要进一步改进以提高程序安全性。