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Perforation of myocardial wall and great vessels after cardiovascular interventions-a 5-year analysis
Zdenek Provaznik1, Andreas Holzamer1, Daniele Camboni1
1Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Insights
Iatrogenic cardiac perforation is a rare but serious complication of cardiovascular procedures. Left ventricular perforation carries a high mortality rate, emphasizing the need for prompt diagnosis and management.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Minimally invasive cardiovascular procedures are increasingly common.
- Iatrogenic cardiac perforation is a severe complication requiring urgent attention.
Purpose of the Study:
- To evaluate the outcomes of iatrogenic cardiac perforation.
- To identify risk factors and management strategies for cardiac perforation.
Main Methods:
- Retrospective study of 44 patients with iatrogenic cardiac perforation (March 2011-April 2016).
- Exclusion of complications from transapical transcutaneous aortic valve replacements (TAVR) and percutaneous coronary intervention (PCI).
- Analysis of symptoms, treatment, intraoperative findings, and outcomes.
Main Results:
- Right ventricle (59.1%) and left ventricle (18.2%) were most commonly perforated.
- Open surgery was required in 61.4% of cases.
- Mortality was 75.0% for left ventricular laceration versus 11.5% for right ventricular laceration.
Conclusions:
- Iatrogenic cardiac perforation is a rare, life-threatening complication of percutaneous interventions.
- High mortality rates persist, especially following left ventricular injury.
- Immediate treatment is crucial but challenging.
Background:
Less invasive procedures have replaced open surgical treatment in many cardiovascular disorders. During these interventions, iatrogenic cardiac perforation may ensue, which is a severe complication and requires immediate diagnostic assessment and treatment.
Methods:
From March 2011 to April 2016, all patients referred to the Dept. of Cardio-thoracic Surgery with the diagnosis of iatrogenic perforation of myocardial wall or great vessels were included into the retrospective study. Complications during transapical transcutaneous aortic valve replacements (TAVR) procedures and percutaneous coronary intervention (PCI) were excluded from analysis. Symptoms, therapeutic strategy, intraoperative findings, and outcome were evaluated.
Results:
Forty-four patients suffered from myocardial wall or vessel perforation. Most common site of perforation were right (n=26; 59.1%) and left (n=8; 18.2%) ventricle. Other structures were involved in ten cases (22.7%). Open surgical treatment was required in 27 cases (61.4%). Mortality after left and right ventricular laceration was 75.0% and 11.5%, respectively. Most common cause of death was cardiocirculatory failure (n=5).
Conclusions:
Iatrogenic perforation of myocardial wall or central vessels during percutaneous interventional procedures is a rare but life-threatening complication. Despite immediate treatment efforts, mortality is high, particularly after left ventricular laceration.
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