Conclusion 

Video assisted thoracoscopic surgical exploration for iatrogenic perforations after invasive cardiac procedures is equally effective as full sternotomy. 30-day mortality is significantly lower when compared to standard sternotomy. Key to a good outcome is fast intervention when hemodynamic doubt is present. The danger of underestimating the perforation greatly outweighs the relatively minor risks of thoracoscopic evaluation. We stress that the study population is too small to make a solid statement. Our results are hypothesis-generating. A larger, randomized, multicentre validation study is needed.