Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery

Abstract

Valvular heart disease (VHD) is one of the most frequent causes of heart failure (HF) and is associated with poor prognosis, particularly among patients with conservative management. The development and improvement of catheter-based VHD interventions have broadened the indications for transcatheter valve interventions from inoperable/high-risk patients to younger/lower-risk patients. Cardiogenic shock (CS) associated with severe VHD is a clinical condition with a very high risk of mortality for which surgical treatment is often deemed a prohibitive risk. Transcatheter valve interventions might be a promising alternative in this setting given that they are less invasive. However, supportive scientific evidence is scarce and often limited to small case series. Current guidelines on VHD do not contain specific recommendations on how to manage patients with both VHD and CS. The purpose of this clinical consensus statement, developed by a group of international experts invited by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Scientific Documents and Initiatives Committee, is to perform a review of the available scientific evidence on the management of CS associated with left-sided VHD and to provide a rationale and practical approach for the application of transcatheter valve interventions in this specific clinical setting.

Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication

“…The state-of-the-art treatment of CS complicated by VHD is considered to be surgery, which directly addresses the pathology and provides immediate repair or replacement of the valve. However, currently, there are no societal guidelines specifically addressing the usability of most transcatheter interventions in the acute setting, besides recently published expert consensus [ 12 , 13 ]. This comes as a result of the exclusion of CS patients from landmark randomized controlled studies (RCTs) and the limited evidence of such interventions in the setting of acute HF and CS, thus leaving the decision on which intervention to perform with the heart team of each institution.…”

CAG peptide functionalized graphene quantum dots-cationic polymer composite gene carriers

“…1 Current treatments include surgery and interventions, but there is a risk of adverse effects such as endothelial hyperplasia. 2 Therefore, the development of tissue engineered blood vessels (TEBVs) with good biocompatibility and rapid endothelialization is key to the treatment of cardiovascular diseases. 3…”