International journal of cardiology · 2026
Temporal trends in causes, management and outcomes of cardiac tamponade complicating TAVI: A 12-year single-center experience.
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Hussein Hossameldin, Elsherif Ahmed, Mechery Anthony, Lawton Ewa, Parsley Dionne, George Sudhakar, Nadir Adnan, Doshi Sagar N
Аннотация
BACKGROUND: Cardiac tamponade is an uncommon but life-threatening complication of transcatheter aortic valve implantation (TAVI). Despite advances in imaging, device design, and operator experience, it remains associated with high morbidity and mortality.
METHODS: We retrospectively analyzed all consecutive TAVI procedures performed at a high-volume tertiary center between 2013 and 2025. Baseline characteristics, procedural details, mechanisms of tamponade, and outcomes were obtained from institutional databases.
RESULTS: Among 2354 TAVI procedures, 29 cases of tamponade occurred (1.2%). The mean age was 78 years, and 65.5% were women. Balloon-expandable valves were used in all but one case. Annular rupture was the leading mechanism (51.7%), followed by LV and RV perforation (13.8% each), while 20.7% had an indeterminate source. Pericardiocentesis was performed in 90% of cases, and 37.9% underwent sternotomy. In-hospital and 90-day mortality were 41.4% and 51.7%, respectively. Annular rupture showed a trend toward higher 90-day mortality than ventricular perforation (66.7% vs 25%, p = 0.09). Temporal analysis demonstrated a significant decline in incidence, from 2.29% between 2013-2018 to 0.86% between 2019-2025 (p = 0.004). This reduction was mainly driven by eliminating RV perforation through adoption of LV-wire pacing. The 90-day mortality improved numerically over time (64% early vs 40% late), although not reaching statistical significance.
CONCLUSIONS: In this high-volume single-center registry, the incidence of tamponade declined over time, driven mainly by a reduction in ventricular perforation. Annular rupture persisted as the dominant and most lethal mechanism, whereas ventricular perforation showed better outcomes. More advanced risk-stratification tools are needed to identify patients at heightened risk.
METHODS: We retrospectively analyzed all consecutive TAVI procedures performed at a high-volume tertiary center between 2013 and 2025. Baseline characteristics, procedural details, mechanisms of tamponade, and outcomes were obtained from institutional databases.
RESULTS: Among 2354 TAVI procedures, 29 cases of tamponade occurred (1.2%). The mean age was 78 years, and 65.5% were women. Balloon-expandable valves were used in all but one case. Annular rupture was the leading mechanism (51.7%), followed by LV and RV perforation (13.8% each), while 20.7% had an indeterminate source. Pericardiocentesis was performed in 90% of cases, and 37.9% underwent sternotomy. In-hospital and 90-day mortality were 41.4% and 51.7%, respectively. Annular rupture showed a trend toward higher 90-day mortality than ventricular perforation (66.7% vs 25%, p = 0.09). Temporal analysis demonstrated a significant decline in incidence, from 2.29% between 2013-2018 to 0.86% between 2019-2025 (p = 0.004). This reduction was mainly driven by eliminating RV perforation through adoption of LV-wire pacing. The 90-day mortality improved numerically over time (64% early vs 40% late), although not reaching statistical significance.
CONCLUSIONS: In this high-volume single-center registry, the incidence of tamponade declined over time, driven mainly by a reduction in ventricular perforation. Annular rupture persisted as the dominant and most lethal mechanism, whereas ventricular perforation showed better outcomes. More advanced risk-stratification tools are needed to identify patients at heightened risk.