This handout is for cardiac tamponade — post-tavr (transcatheter aortic valve replacement). Your care team identified this based on: intra-procedural hypotension/bradycardia/arrest in tavr suite during catheter manipulation, balloon valvuloplasty, valve deployment, or temporary pacing — stat tee for perforation site (varc-3 pmid 34304871).
Other reasons your team may use this plan: post-tavr hemodynamic decompensation within first 24h post-procedure → late perforation or annulus rupture extravasation (yashima jacc cardiovasc interv 2017); new pericardial effusion on intra-procedural tee or immediate post-tavr echo (varc-3 pmid 34304871); annulus rupture with contrast extravasation visualized on completion aortogram — life-threatening; immediate cardiac surgery activation (pasic jacc 2015).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| normal saline | 500-1000 mL bolus | IV | rapid bolus then reassess | Bridge preload (ESC 2015) |
| norepinephrine | 0.05-0.1 µg/kg/min titrate to MAP ≥65 | IV | continuous | Bridge only — does not address obstruction; particularly important in elderly TAVR population (Roy JAMA 2007) |
| protamine | 1 mg per 100 U residual UFH (max 50 mg single dose); typical TAVR dose 30-50 mg given ACT 250-300 procedural target | IV | slow IV over 10 min | Reverse procedural UFH; standard TAVR tamponade reversal (VARC-3; Bhatt 2018) |
| phytonadione | 10 mg IV slow over 10 min | IV | single dose | Vit K reverses warfarin synthesis defect; works over 6-12h (Bhatt Circulation 2018) |
| 4-factor prothrombin complex concentrate | 25-50 U/kg based on INR | IV | single dose | Immediate factor replacement for warfarin reversal in major bleeding (Bhatt Circulation 2018) |
| idarucizumab | 5 g IV (2 × 2.5 g vials) | IV | single dose | RE-VERSE AD (Pollack NEJM 2017 PMID 28793172) — complete reversal within minutes |
| andexanet alfa | low dose 400 mg bolus + 4 mg/min × 2h OR high dose 800 mg bolus + 8 mg/min × 2h based on FXa-DOAC dose + timing | IV | bolus + infusion | ANNEXA-4 (Connolly NEJM 2019 PMID 30730782) — rapid anti-FXa reversal |
| packed red blood cells | Goal Hb >7 (>8 if ongoing ischemia); MTP 1:1:1 PRBC:FFP:plt if massive | IV | as needed | TRICC + restrictive transfusion; MTP if massive bleeding (Holcomb JAMA 2015) |
Plan: Post-TAVR tamponade — emergent drainage + protamine reversal + simultaneous cardiac surgery readiness (VARC-3 PMID 34304871; ESC 2015 §Iatrogenic; Bhatt Circulation 2018)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Guideline: VARC-3 TAVR endpoint definitions (Généreux JACC 2021 PMID 34304871) + 2020 ACC/AHA Valvular Heart Disease Guideline (Otto JACC 2021 PMID 33342586) + 2015 ESC pericardial diseases (Adler EHJ 2015 PMID 26320112). VARC-3 anchors TAVR-complication classification and management; Otto 2021 anchors TAVR indications + post-procedural antithrombotic strategy; ESC 2015 anchors tamponade physiology + drainage approach.