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

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

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  • 1Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.

Abstract

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.

Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID:
23257375
[PubMed - indexed for MEDLINE]
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