title: Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study.
abstract: OBJECTIVE
  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.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rezq
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basavarajaiah
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Tasuku
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.forename: Annalisa
authors.initials: A
authors.lastname: Franco
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Nicola
authors.initials: N
authors.lastname: Corvaja
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization; D002305:Cardiac Tamponade / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome