Author + information
- Received February 28, 2012
- Revision received July 12, 2012
- Accepted August 2, 2012
- Published online December 1, 2012.
- Ahmed Rezq, MD⁎,†,‡,
- Sandeep Basavarajaiah, MD⁎,†,
- Azeem Latib, MD⁎,†,
- Kensuke Takagi, MD⁎,†,§,
- Tasuku Hasegawa, MD⁎,†,
- Filippo Figini, MD⁎,
- Micaela Cioni, MD∥,
- Annalisa Franco, MD¶,
- Matteo Montorfano, MD⁎,
- Alaide Chieffo, MD⁎,
- Francesco Maisano, MD∥,
- Nicola Corvaja, MD#,
- Ottavio Alfieri, MD∥ and
- Antonio Colombo, MD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Antonio Colombo, EMO-GVM Centro Cuore Columbus, Interventional Cardiology Unit, San Raffaele Scientific Institute, 48 Via M. Buonarroti, 20145 Milan, Italy
Objectives The aim of this study was to explore the incidence, causes, and outcomes of cardiac tamponade in patients undergoing transcatheter aortic valve implantation (TAVI).
Background Use of TAVI is increasing, but the procedure is vulnerable to complications, given the cohort of patients. Cardiac tamponade is a possible complication, and there is a scarcity of data on the incidence and outcomes of cardiac tamponade during TAVI.
Methods All patients who sustained cardiac tamponade during or post-TAVI between 2007 and 2012 were included in the study.
Results Of 389 patients who underwent TAVI, 17 (4.3%) had cardiac tamponade. The mean age was 82.3 ± 3.7 years, and most were women (n = 12, 70.6%). Causes of cardiac tamponade were right ventricular perforation by temporary pacemaker (9 patients, 52.9%), annular rupture or aortic dissection (4 patients, 23.5%), and tear in the left ventricular free wall caused by Amplatz stiff wire or catheters (4 patients, 23.5%). Mortality occurred in 4 patients (23.5%), and all had tamponade caused by injury to the high-pressured left-sided circulation (left ventricle and aorta). Most patients (n = 14, 82.4%) sustained cardiac tamponade during the procedure—2 patients (11.7%) within 24 h, and 1 patient after 24 h.
Conclusions Cardiac tamponade during TAVI is not frequent but is associated with high mortality rates especially when left-sided structures are involved. Meticulous handling of the equipment and improvements in the safety of currently used devices could further reduce the occurrence of this complication.
Dr. Latib is on the advisory board for Medtronic. Dr Montorfano is a proctor for Edwards. Dr Maisano is a consultant for Abbot Vascular, Edwards, Medtronic, St. Jude Medical, Valtech Cardio and founder of 4tech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 28, 2012.
- Revision received July 12, 2012.
- Accepted August 2, 2012.
- American College of Cardiology Foundation