Introduction

Invasive cardiac procedures such as percutaneous coronary interventions and electrophysiology procedures have been well established as an effective treatment for coronary lesions and cardiac arrhythmias. Due to their increasing caseload, the low frequency of procedure-related complications can still be a substantial patient group in high-volume centres(1), especially at times when the use of antiplatelet and anticoagulation medication is increasing(2). Acute tamponade due to cardiac perforation is a life-threatening complication. It has been reported that tamponade complicates 0,09-1,42% of invasive cardiac procedures in high-volume centres(3). In most cases, the primary management is pericardiocentesis. However, this is insufficient in up to 50% of tamponade cases(1). When non-surgical management fails, urgent surgical exploration is required. The standard surgical approach is almost exclusively by median sternotomy(4). We propose a less invasive technique by thoracoscopic exploration. The aim of this study is to analyse the benefits of video assisted thoracoscopic surgery (VATS) in the surgical treatment of iatrogenic cardiac perforation compared to sternotomy.