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 ( 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.