Ventricular perforation

The use of transcatheter aortic valve implantation (TAVI) continues to grow worldwide, with over 100 000 procedures performed between 2002 and 2013. Along with the significant clinical benefit demonstrated from transfemoral (TF) TAVI compared to surgical aortic valve replacement (SAVR) in high-to-moderate risk patients, recent clinical trials showed non-inferiority of TF-TAVI with self-expandable valves and superiority with balloon-expandable valves, even in low risk patients. This chapter presents the current knowledge on diagnosis, management and prevention of left-and right-sided ventricular perforation (VP) complicating TF-TAVI. The clinical presentation of VP can be highly variable, ranging from rapid-onset cardiac tamponade to a "silent" LV pseudoaneurysm. Some techniques for LV perforation repairs are extrapolated from free wall ruptures secondary to acute myocardial infarctions (noting the difference of surrounding viable myocardium) while other techniques are extrapolated from repair of cardiac traumatic injuries.