Key result
Cardiac tamponade complicates ~2% of TAVR cases with no decline over time, driven by LV perforation.
Why the study?
Mechanistic insights were needed regarding cardiac tamponade complicating TAVR, which typically results from RV injury, LV injury, or annular rupture.
Observational (n=1,247)
No
Absolute Event Rate: 1.4% vs 1.9%
p-value: p=0.44
Cardiac tamponade is a rare (1.7%) complication of TAVR, most frequently caused by left ventricular perforation from guidewires, highlighting the importance of meticulous guidewire insertion protocols.
Persistent tamponade risk from LV perforation in TAVR; hypothesis-generating for targeted wire safety protocols.
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 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- R ESUM EContexte : La tamponnade cardiaque compliquant le remplacement valvulaire aortique par cath eter (RVAC) r esulte g en eralement d'une l esion au ventricule droit (VD) induite par l' electrode d'un stimulateur cardiaque, d'une l esion au ventricule gauche (VG) induite par les filsguides et les cath eters utilis es durant l'intervention, et la rupture de l'anneau aortique pendant l'implantation de la valve.M ethodologie : Nous avons proc ed e une analyse r etrospective de la base de donn ees sur les RVAC pratiqu es dans notre etablissement pour mieux comprendre les m ecanismes qui sous-tendent cette complication.R esultats : Au total, 1 247 RVAC ont et e pratiqu es entre 2010 et 2024.Une tamponnade cardiaque a compliqu e 21 de ces interventions (1,7 %).Une r eduction non significative de la survenue de la tamponnade (1,9 % parmi les 623 premiers cas vs 1,4 % parmi les 624 cas subs equents; p 0,44) a et e observ ee.La tamponnade a et e caus ee par la perforation du VG dans 10 cas (48 %), la perforation du VD induite par le stimulateur cardiaque dans 8 cas (38 %) et la rupture de l'anneau aortique dans 3 cas (14 %).Nous avons rep er e deux m ecanismes l'origine de la perforation du VG : le fil-guide rigide utilis e pour acheminer la valve a provoqu e une l esion myocardique Methods Study populationConsecutive patients with severe symptomatic aortic stenosis who were referred for TAVR at our institution were CJC Open 7 (2025) 153e160
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Naoum et al. (2024) conducted an observational in Severe symptomatic aortic stenosis (n=1,247). Transcatheter aortic valve replacement (TAVR) vs. Early TAVR cases was evaluated on Cardiac tamponade (p=0.44). Cardiac tamponade complicated 1.7% of TAVR procedures, with no significant reduction between early and late cases (1.9% vs 1.4%; P=0.44), and was primarily caused by left ventricular perforation.
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