Minimally Invasive Management of Cardiac Tamponade Complicating Transcatheter Aortic Valve Implantation: A Technical Note

PURPOSE: Cardiac tamponade is an uncommon but potentially catastrophic complication of transcatheter aortic valve implantation (TAVI), particularly when caused by iatrogenic hemopericardium, with high mortality among patients requiring emergency cardiac surgery. We describe a structured minimally invasive subxiphoid protocol modification for immediate intraprocedural tamponade management and place this experience in the context of current evidence. MATERIALS AND METHODS: Between January 2023 and April 2026, cardiac tamponade developed intra- or peri-procedurally in 4 consecutive patients among approximately 350 TAVI procedures at a single tertiary center. The protocol comprised immediate subxiphoid decompression; insertion of two 16 Fr radiopaque Redon drains, placed anteriorly and posteriorly, each connected to a separate Drainobag bottle sustaining high negative pressure; hermetic layered closure; mechanical ventilation under sedation after decompression for at least 12 hours and progressive drain removal after 72 hours. RESULTS: All 4 patients achieved immediate hemodynamic recovery without conversion to emergency sternotomy. No hospital deaths or procedure-related complications occurred. No late pericardial reaccumulation, constrictive pericarditis or ventricular pseudoaneurysm occurred. CONCLUSION: In this small single-center series, dual-drain subxiphoid drainage with continuous high-vacuum aspiration was feasible and associated with hemodynamic recovery without emergency sternotomy in 4 selected TAVI patients. Larger comparative studies are required before broader use can be recommended. These observations should be considered hypothesis-generating.Clinical ImpactCardiac tamponade during TAVI requires rapid, mechanism-directed treatment. Image-guided pericardiocentesis remains the usual first drainage step, whereas ongoing iatrogenic hemopericardium or failure to stabilize requires immediate surgical escalation. In 4 carefully selected patients, dual-drain subxiphoid decompression with continuous high-vacuum aspiration restored hemodynamic stability without emergency sternotomy. These findings support its feasibility as a rescue option in carefully selected cases, while larger comparative studies are needed to define its hemostatic effectiveness and its role relative to conventional drainage. Persistent bleeding or recurrent hemodynamic instability should prompt surgical conversion.