Original title: Incidence, Management and Outcomes of Cardiac Tamponade During Transcatheter Aortic Valve Implantation Reference: Ahmed Rezq et al. J Am Coll Cardiol Intv 2012;5:1264 –72
Transcatheter Aortic Valve Implantation (TAVI) for high risk patients is a valid strategy today but not without complications. Among these is cardiac tamponade, still rare but important because of its implication.
There are few data on the incidence and evolution. This retrospective analysis of a single center evaluated 389 patients receiving TAVI between November 2007 and January 2012 of which 17 (4.3%) had a cardiac tamponade complication. Patients presenting cardiac tamponade were older (82.5 ± 3.6 years vs. 79.2 ± 7.7, p = 0.07), female (n = 12, 70.5%) and lowest height (159.2 ± 5.4 cm vs. 164.6 ± 8.3 cm, P = 0.01). The other characteristics were similar to the rest of the population. Of the 17 patients with cardiac tamponade, 9 received Edwards Sapiens (7 femoral and 2 transapical) and 8 received CoreValve (7 by femoral access and 1 by transaxillary acess). Predilatation in 10 patients and post-dilatation in 5.
The sites of origin were: tear of ring in 3 (17.6%), left ventricular tear 4 (23.5%), right ventricular perforation 9 (52.9%) and a probable aortic dissection in 1 (5.9%). Presentation of cardiac tamponade was in 14 patients during the procedure (3 annular tears, 4 tear of left ventricle and 7 perforation of the right ventricle), 2 patients within 24 hours of perforation of the right ventricle and one after 24 hours, probable dissection aortic. Mortality was 4 patients (23.5%), all of them by left tear source.
Conclusion
Cardiac tamponade during percutaneous aortic valve replacement is rare but associated with high mortality, especially when committed left structures.
Editorial Comment:
The limitation of this analysis is that it has been performed at a single center retrospectively, but it highlights a serious complication of TAVI. We also note that the majority of the perforations in the right structures is not related to mortality unlike left origin. Despite this, the placement of a temporary pacemaker should be one of the simplest steps of the procedure, is also a major cause of clogging. It is important to know that women and people of short stature are the most exposed. Experience is very important when performing TAVI as well as developing new guides, valves and balloons that increase security.
Courtesy of Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina.
Dr. Carlos Fava para SOLACI.ORG