Cardiac Tamponade Complicating Transcatheter Aortic Valve Replacement: Insights From a Single-Center Registry

Cardiac tamponade complicating transcatheter aortic valve replacement (TAVR) typically results from right ventricular (RV) injury induced by a pacemaker electrode, left ventricular (LV) injury induced by guidewires and catheters used during the procedure, and rupture of the aortic annulus during valve implantation.

We retrospectively analysed our institutional TAVR database to gain mechanistic insights relating to this complication.

A total of 1247 TAVR procedures were performed from 2010 to 2024. Cardiac tamponade complicated 21 (1.7%) of these procedures. There was a nonsignificant reduction in occurrence of tamponade (1.9% among the first 623 cases vs 1.4% among the subsequent 624 cases; P = 0.44). Tamponade was caused by LV perforation in 10 cases (48%), pacemaker-induced RV perforation in 8 cases (38%), and annular rupture in 3 cases (14%). We identified 2 mechanisms causing LV perforation: The stiff guidewire used for valve delivery caused myocardial injury in 7 cases, and in the other 3 cases, LV perforation occurred before insertion of the stiff guidewire and was attributed to insertion of soft guidewires. No additional such cases occurred after implementation of a protocol for meticulous guidewire insertion into the LV. Pericardiocentesis was performed with tamponade in 20 patients and with cardiac surgery in 13. Nine patients (43%) died during the index hospitalisation. Mortality did not differ between cases with RV perforation and left-side perforation.

Periprocedural cardiac tamponade during TAVR may be caused by various mechanisms. Careful guidewire manipulation may decrease occurrence of LV perforation.