Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study

JACC Cardiovasc Interv. 2012 Dec;5(12):1264-72. doi: 10.1016/j.jcin.2012.08.012.


Objectives: The aim of this study was to explore the incidence, causes, and outcomes of cardiac tamponade in patients undergoing transcatheter aortic valve implantation (TAVI).

Background: Use of TAVI is increasing, but the procedure is vulnerable to complications, given the cohort of patients. Cardiac tamponade is a possible complication, and there is a scarcity of data on the incidence and outcomes of cardiac tamponade during TAVI.

Methods: All patients who sustained cardiac tamponade during or post-TAVI between 2007 and 2012 were included in the study.

Results: Of 389 patients who underwent TAVI, 17 (4.3%) had cardiac tamponade. The mean age was 82.3 ± 3.7 years, and most were women (n = 12, 70.6%). Causes of cardiac tamponade were right ventricular perforation by temporary pacemaker (9 patients, 52.9%), annular rupture or aortic dissection (4 patients, 23.5%), and tear in the left ventricular free wall caused by Amplatz stiff wire or catheters (4 patients, 23.5%). Mortality occurred in 4 patients (23.5%), and all had tamponade caused by injury to the high-pressured left-sided circulation (left ventricle and aorta). Most patients (n = 14, 82.4%) sustained cardiac tamponade during the procedure-2 patients (11.7%) within 24 h, and 1 patient after 24 h.

Conclusions: Cardiac tamponade during TAVI is not frequent but is associated with high mortality rates especially when left-sided structures are involved. Meticulous handling of the equipment and improvements in the safety of currently used devices could further reduce the occurrence of this complication.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Cardiac Catheterization*
  • Cardiac Tamponade / epidemiology*
  • Cardiac Tamponade / etiology*
  • Cardiac Tamponade / therapy
  • Cohort Studies
  • Female
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Incidence
  • Intraoperative Complications / epidemiology*
  • Intraoperative Complications / etiology*
  • Intraoperative Complications / therapy
  • Male
  • Retrospective Studies
  • Treatment Outcome