Abstract Aims Iatrogenic cardiac perforation is an uncommon but potentially fatal complication of invasive cardiac procedures. When nonsurgical management fails, urgent cardiac surgery is required. The standard surgical approach is usually through full sternotomy. However, we propose a less invasive and equally effective technique with video‐assisted thoracoscopic surgery (VATS). Methods This single‐center retrospective study in a tertiary hospital identified all patients requiring surgical intervention due to iatrogenic cardiac perforation over a period of 5 years. Patients were grouped by surgical approach, being either sternotomy or VATS. Primary endpoints were operating time, length of ICU stay, hospital stay, 30‐day mortality, and all‐round mortality. Results Twenty‐five patients were identified: 11 in the sternotomy group and 14 in the VATS‐group. Preoperative baseline characteristics were equal. Significant difference was found for 30‐day mortality (p?
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