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

Background: 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. Methods: We retrospectively analysed our institutional TAVR database to gain mechanistic insights relating to this complication. Results: 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 fi 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 tampo nade 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. Conclusions: Periprocedural cardiac tamponade during TAVR may be caused by various mechanisms. Careful guidewire manipulation may decrease occurrence of LV perforation.