Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis.
OBJECTIVE
To assess outcomes of TAVR as a rescue therapy in patients with cardiogenic shock due to acutely decompensated aortic stenosis.


RESULTS
Of 771 high-risk patients who underwent TAVR, 27 (3.5%; 78±9 years; 12 men) were treated emergently due to acutely decompensated aortic stenosis with cardiogenic shock. SAPIEN and CoreValve prostheses were implanted in 11 and 16 patients, respectively: the transfemoral access route was used in 25. Three patients died within 72 hours of successful valve deployment, and a further six died within a month, giving a 30-day mortality of 33.3%, which was significantly higher than in electively treated patients (7.7%, p<0.0001). Univariate predictors of 30-day mortality in cardiogenic-shock patients were baseline cardiac output <3.0 l/min, reduced cardiac power index, impaired renal function, and mechanical ventilation, as well as severe acute kidney injury after TAVR. Estimated one-year survival was 59.3% in emergently and 82.7% in electively treated patients (p=0.0009). However, 30-day landmark analysis showed no difference in cumulative survival between TAVR modalities. In cardiogenic-shock patients without concomitant reduced cardiac output and impaired renal function at baseline (n=22), estimated one-year survival was 72.7%.


CONCLUSIONS
TAVR should be considered a reasonable rescue therapy in patients with cardiogenic shock secondary to decompensated aortic stenosis.
Department of Cardiology, Asklepios Klinik, St. Georg Hospital, Hamburg, Germany.
Christian
C
Frerker
Jury
J
Schewel
Michael
M
Schlüter
Dimitry
D
Schewel
Hassan
H
Ramadan
Tobias
T
Schmidt
Thomas
T
Thielsen
Felix
F
Kreidel
Friederike
F
Schlingloff
Ralf
R
Bader
Peter
P
Wohlmuth
Ulrich
U
Schäfer
Karl-Heinz
KH
Kuck
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000601:surgery*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome