Adequacy and Safety of Liver Biopsy Performed During Cardiac Catheterization in Patients With Fontan and Non-Fontan Heart Disease.

BACKGROUND AND AIMS: Liver biopsy is the gold standard for diagnosis of hepatic fibrosis. Biopsy performed during cardiac catheterization is a unique approach performed at few centers. It allows for simultaneous hepatic and cardiac assessment and may be useful in the surveillance of Fontan-associated liver disease, a recognized complication in Fontan patients. This study reviews the indications, outcomes, and adequacy of liver biopsy performed during cardiac catheterization, with special attention to patients with Fontan-associated liver disease.

METHODS

A multidisciplinary, retrospective review of patients at a single quaternary-care center who underwent liver biopsy during right heart catheterization was performed. One hundred thirty liver biopsies taken between December 2011 and October 2022 were analyzed.

RESULTS

There were 80 biopsies in non-Fontan patients and 50 in Fontan patients. Between the non-Fontan and Fontan cohorts, indications for cardiac catheterization were clinically warranted hemodynamic assessment or assessment of Fontan circulation (50% vs 88%), new or progressive heart failure symptoms (46.2% vs 8%), and arrhythmia (3.8% vs 4%). There were fewer average number of biopsy passes during the Fontan patients' procedures, 2.9 vs 3.5 (P = .046), though average fluoroscopy time was longer, 12.4 vs 6.3 minutes (P < .001). In total, 88.5% of biopsies were classified as "adequate," 9.2% were "limited," and 2.3% were "inadequate." A definitive histopathologic diagnosis was reached in 99.2% of biopsies, with the only undiagnosed specimen in the Fontan group.

CONCLUSION

Liver biopsy during a clinically warranted cardiac catheterization can be safely performed with adequate yield and minimal complication risk. It may be useful in Fontan patients undergoing catheterization to assess Fontan-associated liver disease development.