Outcomes of emergency transcatheter aortic valve replacement in patients with cardiogenic shock: A multicenter retrospective study.
Pierre-Guillaume PiriouThibaut ManigoldVincent LetocartRobin Le RuzGuillaume SchurtzFlavien VincentÉric Van BellePatrice GuérinJulien PlessisPublished in: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2022)
Rescue transcatheter aortic valve replacement (TAVR) in patients with cardiogenic shock is challenging, and there is limited literature on these critical patients. The aim of this study was to determine the characteristics and outcomes of patients undergoing TAVR, feasibility and safety of the procedure, and 1-year mortality factors. Thirty-eight patients with severe aortic disease and cardiogenic shock admitted to two French hospitals from 2015 to 2019 were included. The patients were critical, 78.9% of them had a left ventricular ejection fraction of <30%, and all of them received inotropic support. "Valve-in-valve" procedures were performed in 15.8% and 13.2% underwent balloon aortic valvuloplasty before TAVR. Edwards Sapien3® and Medtronic CoreValve EvolutR® were used. The survival probability remained reasonable for patients with cardiogenic shock who underwent rescue TAVR. The 30-day mortality rate was 7.9% and 21.1% at 1 year. No patient died during the intervention. The procedure was safe, with few complications except for acute kidney failure, the development of a left bundle branch block, and the need for pacemaker implantation. Both functional and echocardiographic results were good at 1 year, although 29% of the patients underwent rehospitalization within 1 year. The development of a left bundle branch block was found to be a mortality risk factor. This procedure is a safe and effective therapy with acceptable survivorship in critically ill patients. The benefits to their quality of life should be evaluated in future studies, and the need for providing early cardiac resynchronization therapy must be emphasized.
Keyphrases
- aortic stenosis
- ejection fraction
- transcatheter aortic valve replacement
- aortic valve
- transcatheter aortic valve implantation
- left ventricular
- risk factors
- newly diagnosed
- patients undergoing
- heart failure
- emergency department
- prognostic factors
- randomized controlled trial
- cardiovascular disease
- minimally invasive
- coronary artery disease
- systematic review
- mitral valve
- patient reported outcomes
- cardiovascular events
- pulmonary hypertension
- acute myocardial infarction
- early onset
- weight loss
- cross sectional
- acute coronary syndrome
- acute respiratory distress syndrome
- drug induced
- extracorporeal membrane oxygenation
- smoking cessation
- adipose tissue
- case report