Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation

A single-center study

Ahmed Rezq, Sandeep Basavarajaiah, Azeem Latib, Kensuke Takagi, Tasuku Hasegawa, Filippo Figini, Micaela Cioni, Annalisa Franco, Matteo Montorfano, Alaide Chieffo, Francesco Maisano, Nicola Corvaja, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1264-1272
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume5
Issue number12
DOIs
Publication statusPublished - Dec 2012

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Cardiac Tamponade
Incidence
Transcatheter Aortic Valve Replacement
Aortic Rupture
Equipment and Supplies
Mortality
Tears
Heart Ventricles
Aorta
Dissection
Catheters

Keywords

  • tamponade in TAVI
  • TAVI
  • TAVI complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation : A single-center study. / Rezq, Ahmed; Basavarajaiah, Sandeep; Latib, Azeem; Takagi, Kensuke; Hasegawa, Tasuku; Figini, Filippo; Cioni, Micaela; Franco, Annalisa; Montorfano, Matteo; Chieffo, Alaide; Maisano, Francesco; Corvaja, Nicola; Alfieri, Ottavio; Colombo, Antonio.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 12, 12.2012, p. 1264-1272.

Research output: Contribution to journalArticle

Rezq, A, Basavarajaiah, S, Latib, A, Takagi, K, Hasegawa, T, Figini, F, Cioni, M, Franco, A, Montorfano, M, Chieffo, A, Maisano, F, Corvaja, N, Alfieri, O & Colombo, A 2012, 'Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: A single-center study', JACC: Cardiovascular Interventions, vol. 5, no. 12, pp. 1264-1272. https://doi.org/10.1016/j.jcin.2012.08.012
Rezq, Ahmed ; Basavarajaiah, Sandeep ; Latib, Azeem ; Takagi, Kensuke ; Hasegawa, Tasuku ; Figini, Filippo ; Cioni, Micaela ; Franco, Annalisa ; Montorfano, Matteo ; Chieffo, Alaide ; Maisano, Francesco ; Corvaja, Nicola ; Alfieri, Ottavio ; Colombo, Antonio. / Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation : A single-center study. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 12. pp. 1264-1272.
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abstract = "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.",
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