Transapical transcatheter aortic valve replacement in patients with cardiogenic shock.
Transcatheter aortic valve implantation (TAVI) has been introduced to treat patients at high risk for conventional surgery; however, cardiogenic shock is considered a contraindication for TAVI. The aim of the present study was to evaluate early and intermediate mortality of patients in cardiogenic shock undergoing TAVI as a rescue procedure. Patients in cardiogenic shock underwent transapical TAVI with Edwards SAPIEN (Edwards Lifesciences, Irvine, CA, USA) prosthetic valves. Preoperative, perioperative and 1-year follow-up data were analysed. Analysis included 358 patients. Preoperative cardiogenic shock was present in 21 (5.9%) patients. EuroSCORE (cardiogenic shock 73.1 ± 18.9% vs. non-cardiogenic shock 36.0 ± 18.7%; P < 0.0001) and Society of Thoracic Surgeons score (cardiogenic shock 50.8 ± 28.1% vs. non-cardiogenic shock 16.7 ± 12.2%; P < 0.0001) were significantly higher in the cardiogenic shock group, and left ventricular ejection fraction (cardiogenic shock 26.0 ± 13.1% vs. no-cardiogenic shock 51.4 ± 13.0%; P < 0.0001) was significantly lower. Thirty-day mortality was significantly higher in the cardiogenic shock group (cardiogenic shock 19% vs. non-cardiogenic shock 5%; P = 0.02) and 1-year survival significantly lower (cardiogenic shock 46% vs. no-cardiogenic shock 83%; P < 0.0001). At Cox regression, EuroSCORE was the sole determinant for follow-up mortality (odds ratio = 1.02; P = 0.04). TAVI in patients who are in cardiogenic shock is feasible. Although the early and late outcomes are encouraging, a structured strategy should be developed and further experience is needed.
German Heart Institute Berlin, Berlin,  Germany.
Giuseppe
G
D'Ancona
Miralem
M
Pasic
Semih
S
Buz
Thorsten
T
Drews
Stephan
S
Dreysse
Marian
M
Kukucka
Roland
R
Hetzer
Axel
A
Unbehaun
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome