Left ventricle (LV) perforation during percutaneous aortic-valve implantation (TAVI) is a catastrophic adverse event. Since it is a rare complication limited data are available regarding its risk factors. Our objective was to determine the clinical and procedural characteristics associated with LV perforation during TAVI.

We retrospectively analyzed 584consecutive patients who underwent TAVI from 2007 to 2016 in Henri Mondor Hospital. LV perforation was defined by a tamponade with surgical evidence of LV perforation. Clinical and procedural characteristics of patients with and without LV perforation were compared.

LV perforation was reported in 2.2% (N=13/584) of TAVI procedure and the majority of patients (84%, N=11/13) died despite emergency surgical intervention. Patients who experienced LV perforation were more likely to be women (N=10/13, 75%). They had shorter height (157±6cm vs. 164±8cm, P=0.007), smaller LV systolic and diastolic diameters (27±5mm vs. 35±11mm, P=0.009 and 45±6mm vs. 50±9mm, P=0.05 respectively) and greater LV ejection fraction (58±8% vs. 50±14%, P=0.03). Non-trans-femoral access was reported in 38% of patients with vs. 6% in patients without LV perforation (P<0.001). Finally, all patients with LV perforation cumulated the following risk factors: LV systolic diameter ≤38mm, LV ejection fraction ≥40% and height ≤165cm.

The study confirms that LV perforation is a rare but catastrophic event despite surgical treatment. Patients at risk of LV perforation were shorter, had smaller LV size, better LV ejection fraction and were more likely women. The non-femoral approach was associated with a higher risk of perforation. In such patients, TAVI technique may be optimized in order to avoid LV perforation.