Emergent surgical repair via minimally invasive left anterior thoracotomy for left ventricular perforation during transfemoral transcatheter aortic valve implantation: a case report

Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe treatment for severe aortic stenosis. Despite advancements reducing complications, rare life-threatening events like ventricular perforation remain significant challenges. This case details the management of an acute left ventricular perforation during TAVI. Case Summary: A 74-year-old woman with symptomatic severe bicuspid aortic stenosis underwent transfemoral TAVI. Sudden haemodynamic collapse occurred during the device delivery. Transoesophageal echocardiography demonstrated massive pericardial effusion, attributed to guidewire-induced left ventricular perforation. The patient maintained haemodynamic stability with pericardial drainage on cardiopulmonary bypass (CPB). However, pericardial effusion recurred after transitioning from CPB to extracorporeal membrane oxygenation support. Cardiac surgeons repaired the laceration at the apex and achieved haemostasis through minimally invasive left anterior thoracotomy, successfully resolving the intraoperative crisis and rescuing the patient. Discussion: This case illustrates that ventricular perforation/rupture during TAVI, while rare, constitutes a fatal complication. To mitigate this risk, enhanced preoperative risk stratification and intraprocedural monitoring for left or right ventricular perforation/rupture are imperative. Prompt recognition and intervention-including pericardiocentesis, CPB initiation, and surgical haemostasis-are critical upon occurrence. Innovatively employing minimally invasive left anterior thoracotomy for repair in this case significantly reduced surgical trauma, facilitating rapid postoperative recovery.