Heart biopsy

A biopsy is a procedure in which your transplant cardiologist will take a tiny sample of your heart tissue. A sample will come from the inner surface (endocardium) of your heart.

You may also hear this procedure called by its formal name, endomyocardial biopsy.


This biopsy is the single most helpful test to tell if your body is rejecting your new heart. This test can help your cardiologist find rejection in its very early stage, even before you notice any symptoms.

The biopsy is done in the Catheterization Lab, on the third floor of the Heart Hospital. You will be awake for the procedure.


Before the procedure

  • You will wear a hospital gown.
  • You will lie on an exam table.
  • You may be given medicine to help you relax.
  • Members of your care circle may wait in your room.

During the procedure

  • Your neck will be cleaned with a special solution.
  • The cardiologist will inject some numbing medicine into the skin over a vein in your neck.
  • The cardiologist will insert a needle into your vein. He or she will put a bioptome through the needle. (This device will collect the tissue sample.)
  • When the bioptome reaches the correct place, it will take a small tissue sample.
  • You may feel a fluttering or tugging in your chest during the procedure.
  • The cardiologist will remove the needle and the bioptome.
  • Gentle pressure will be placed on the needle insertion site to stop any bleeding. A small dressing or bandage will be put on the area.
  • The health care team members will watch you closely.
  • The biopsy takes about 30 minutes.

After the procedure

  • You may have other tests needed. The transplant coordinator or one of your nurses will give your directions. 
  • The results of the biopsy will be known that same evening or the next day. The transplant coordinator will call you with the results.

Biopsy schedule

You will have regular biopsies after surgery. The schedule is:

  • first month - every week
  • 2 to 3 months - every two weeks
  • 4 to 6 months - every four weeks
  • 7 to 12 months - at nine months and one year
  • after one year - as needed

The above schedule is based on no rejection episodes. If you have an episode of rejection, your transplant doctor will give you a new schedule.

Cardiac Biopsy Grading Scale

Your tissue samples will be graded on a scale:

  • Grade 0 R: no rejection
  • Grade 1 R: mild rejection: The sample shows lymphocytes (white blood cells) with up to one area of heart cell injury.
  • Grade 2 R: moderate rejection: The sample shows two or more areas of lymphocytes with heart cell damage.
  • Grade 3 R: severe rejection: The sample shows many areas of heart cell injury with other signs of heart cell damage.

Risks of cardiac biopsy

The risks known with cardiac biopsy are low. However, tell the nurse or doctor know if you have any of these:

  • shortness of breath
  • chest pain or pressure
  • dizziness
  • weakness

Rarely, air can collect between your lungs and chest wall. This is why you may need a chest X-ray after each biopsy.

Source: Allina Health's Patient Education Department, Care After Heart Transplant, cvs-ahc-95405 (4/13)
First Published: 01/06/2013
Last Reviewed: 01/19/2018