Outcomes of Cardiac Tamponade Post-Transcatheter Aortic Valve Replacement: Results From a Tertiary Cardiac Center

Background

Cardiac tamponade is a rare but potentially lethal complication of transcatheter aortic valve replacement (TAVR). There is paucity of evidence assessing the incidence and outcomes of patients with cardiac tamponade after TAVR.

Methods

A retrospective review was performed of all patients who underwent TAVR at our institution from January 2013 to January 2019. The clinical characteristics of patients who developed cardiac tamponade in the periprocedural period were compared to the patients who did not develop tamponade. Qualitative and quantitative assessment of aortic annular calcium distribution on cardiac computerized tomography was analyzed.

Results

Twenty out of 2030 patients (0.9%) developed cardiac tamponade post-TAVR. The mean age of the cohort developing cardiac tamponade was 81.7 years, and 50% of them were men. Most of these were intraprocedural (70%) while the remaining were identified in the postprocedural period. The site of injury resulting in pericardial tamponade was thought to be from the injury to aortic annulus (50%), right ventricle (40%), and left ventricle (10%). Tamponade due to annular or left ventricular trauma was mostly identified intraprocedurally (91%; n ​= ​10 of 11), while patients with tamponade due to presumed right ventricular injury were mostly identified in the postprocedural period (62.5%; n ​= ​5 of 8) (p ​= ​0.009). Conservative management with supportive therapies was employed in 90% of patients with cardiac tamponade, while two patients had cardiac surgery. There was one in-hospital mortality, and another patient died within 30 days of the TAVR procedure.

Conclusion

The incidence of cardiac tamponade after TAVR (0.9%) was low, and this serious complication can be managed successfully in the majority of patients with streamlined processes in high-volume centers.