Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe symptomatic aortic stenosis. However, cardiac tamponade remains a threatening complication with few reported data.

To investigate the incidence, causes, predictive factors and outcomes of peri-procedural tamponade among TAVI patients.

This study included the patients who consecutively underwent TAVI in two high-volume centres between 2006 and 2017. Baseline characteristics of the patients, procedural details and hospital outcomes were prospectively recorded.

A total of 1957 patients were included (Age: 81.8±2.1 years; male gender, 46%; logistic Euroscore: 16.9±2.9%). A peri-procedural tamponade occurred in n=51 patients (2.6%). The incidence decreased significantly over time: 5.8% for the 2006–2008 period, 3.6% for the 2009–2011 period, 3.5% for the 2012–2014 period and 1.7% for the 2015–2017 period (P=0.03). The causes were: left ventricular perforation by the stiff wire in n=12 patients (24%), right ventricular perforation by pacing leading in n=9 patients (17%), annular rupture in n=12 patients (24%). There was no reported cause in 35% of the cases. The patients were treated by percutaneous pericardiocentesis in n=20 cases (39%), cardiac surgery in n=28 cases (55%) and hemodynamic support only in n=3 cases (6%). Patient age (OR=1.06 (95% CI: 1.01–1.11) per year), baseline left ventricle ejection fraction (OR=1.03 (1.00–1.07) per %), previous chest radiation (OR=3.60 (1.5–8.5)) and non-transfemoral access (OR=2.70 (1.25–8.84)) were independent predictors of peri-procedural tamponade. The occurrence of tamponade severely impaired outcome: the actuarial 30-day survival was 66.4±6.6% in tamponade patients vs. 96.8%±0.4% in the others (P<0.001, log rank test).

Cardiac tamponade during TAVI is a rare complication whose incidence decreased over past years but remains associated with a poor immediate outcome.