Dynamic Tamponade as Treatment: First-in-Human Conservative Approach to Post-TAVI Annular Rupture

Annular rupture is a rare but catastrophic complication of transcatheter aortic valve implantation (TAVI), often necessitating emergent surgical intervention. In patients deemed unsuitable for surgery, alternative conservative strategies must be considered. We report the case of a 77-year-old woman with severe calcific aortic stenosis who underwent transapical TAVI using a 20 mm Sapien S3 Ultra valve. Following postdilatation for residual paravalvular leak, she developed an annular rupture. Due to the patient's prohibitive surgical risk, a unique tamponading technique was adopted: the pericardial drain was left closed to allow physiological tamponade of the bleeding site, with intermittent release of pressure to stabilize hemodynamics. This dynamic drain modulation successfully controlled the bleeding in 48 h and avoided surgical intervention. To our knowledge, this is the first reported case of such a strategy for managing annular rupture post-TAVI. The patient made a full recovery, with preserved valve function and no residual effusion at follow-up.