Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI‐shock registry results

Abstract

Objectives Aim of this study is to evaluate safety, feasibility, and mid‐term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS). Background Balloon aortic valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant. Methods From March 2008 to February 2019, 51 patients with severe aortic valvulopathy (native SAS or degenerated aortic bioprosthesis) and CS treated by TAVI in 11 European centers were included in this multicenter registry. Demographic, clinical, and procedural data were collected, as well as clinical and echocardiographic follow‐up. Results The mean age of our study population was 75.8 ± 13, 49% were women, and mean Society of Thoracic Surgeons (STS) score was 19 ± 15%. Device success was achieved in 94.1%, with a 5% incidence of moderate/severe paravalvular leak. The 30‐day events were mortality 11.8%, stroke 2.0%, vascular complications 5.9%, and acute kidney injury 34%. Valve Academic Research Consortium‐2 early safety endpoint was reached in 35.3% of cases. At 1‐year of follow‐up, the mortality rate was 25.7% and the readmission for congestive heart failure was 8.6%. Conclusions TAVI seems to be a therapeutic option for patients with CS and SAS or degenerated aortic bioprosthesis in terms of both safety and efficacy at early and long‐term follow‐up.

Survival of Severe Aortic Stenosis Complicated with Cardiogenic Shock by Emergent Transcatheter Aortic Valve Implantation and Intra-Aortic Balloon Pump

“…8) According to Fraccaro et al, the 1-year mortality and heart failure readmission rate were 25.7% and 8.6%, respectively. 9) Cardiogenic shock with acutely decompensated AS portends a dismal prognosis; however, the lesson from our case is that prompt management with emergent TAVI and mechanical circulatory support is feasible and may result in a favorable outcome. We did not use extracorporeal membrane oxygenation as the patient did not develop cardio-pulmonary arrest.…”

Early Hemodynamic Recovery after a Successful Transcatheter Aortic Valve Implantation in Cardiogenic Shock Secondary to Severe Bicuspid Aortic Stenosis

“…Moreover, despite high risk of mortality, BAV still remains a valid option in critical aortic stenosis as palliative or bridge procedure. [ 2 ]…”

Mechanical Circulatory Support Devices for the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction—A Review

“…Percutaneous transcatheter heart interventions are a viable alternative to surgery in acutely ill patients at extremely high operative risk. Minimally invasive procedures, with or without MCS support, of both mitral and aortic valves have been described in the setting of CS in small case series and registries, with high procedural success rate and improved outcomes [ 58 , 59 , 60 ]. However, the populations in those specific studies are highly heterogeneous regarding CS etiology and include only small samples of post-AMI CS patients with secondary mitral regurgitation (MR).…”