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Letter to the editor

Published:November 15, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.10.430
      The recently published article, “Physician radiation exposure during endomyocardial biopsy and right heart catheterization,” highlights the role of the transplant and interventional cardiology provider in the care of advanced heart failure patients (
      • Loyaga-Rendon Renzo Y.
      • et al.
      Physician Radiation Exposure during Endomyocardial Biopsy and Right Heart Catheterization.
      ). The authors emphasize that individual practice patterns and proficiency during these procedures can vary the total radiation dose exposure. As previously published, echo-guided biopsy obviates the need to use x-ray devices for catheter manipulation and sample recovery and is considered safe (
      • Bedanova Helena
      • et al.
      Echo-guided endomyocardial biopsy in heart transplant recipients.
      ). Our single-center experience has safely utilized this method over ten years to perform 3,805 biopsies after heart transplantation outside the traditional cath lab using a special sterile procedure room. In most cases, we have also performed 1,960 hemodynamically guided right heart catheterizations without using fluoroscopy. The authors highlight the continued importance of education in complex patient management. In the current climate of COVID-19 and the increase in telehealth, our field may benefit from reconsidering ideal resource utilization, procedural necessity, and future application of newer non-invasive methods to detect cellular rejection with either cell-free DNA testing or broader application of artificial intelligence with EKG (
      • Ruiz Morales J.
      • et al.
      Artificial Intelligence 12 Lead ECG Based Heart Age Estimation and 1-Year Outcomes after Heart Transplantation.
      ); however, if an endomyocardial biopsy is indicated, an echo guided approach in patients with appropriate access should be considered a first-line option.
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      References

        • Loyaga-Rendon Renzo Y.
        • et al.
        Physician Radiation Exposure during Endomyocardial Biopsy and Right Heart Catheterization.
        Journal of Cardiac Failure. 2022; https://doi.org/10.1016/j.cardfail.2022.09.005
        • Bedanova Helena
        • et al.
        Echo-guided endomyocardial biopsy in heart transplant recipients.
        Transplant international: official journal of the European Society for Organ Transplantation. 2004; 17: 622-625https://doi.org/10.1007/s00147-004-0760-1
        • Ruiz Morales J.
        • et al.
        Artificial Intelligence 12 Lead ECG Based Heart Age Estimation and 1-Year Outcomes after Heart Transplantation.
        The Journal of Heart and Lung Transplantation. 2022; 41https://doi.org/10.1016/j.healun.2022.01.1671