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Limited data exist regarding use of mechanical circulatory support (MCS) for cardiogenic shock (CS) in patients undergoing transcatheter aortic valve replacement (TAVR). The Vizient Clinical Database was queried for patients who underwent TAVR between January 1, 2016, and December 31, 2022, and had diagnosis of CS during same admission. Patients who required MCS (MCS-TAVR) were identified. Patients with aborted TAVR, conversion to surgical AVR, free wall rupture, aortic rupture/dissection, pericardial effusion/tamponade, myocardial infarction, and major bleeding were excluded. The primary outcome was in-hospital all-cause death. Out of 2,178 TAVR patients with CS, 363 (16.7%) received MCS, with increasing trend across study years (10.7% in 2016 vs 20.1% in 2022, P<0.001). Patients who received MCS were of similar age and Elixhauser comorbidity score. Intra-aortic balloon pump was the most commonly used MCS (54.3%), followed by percutaneous left ventricular assist device (19.3%), extracorporeal membrane oxygenation (16.5%), with almost 10% receiving dual MCS. MCS-TAVR patients experienced higher in-hospital all-cause death (34.4% vs 10.9%, P<0.001) and hospitalization cost but similar length of stay compared to non-MCS-TAVR patients. In-hospital death with MCS-TAVR for CS did not change over study years (33.3% in 2016 vs 35.2% in 2022, P=0.11). Outcomes with salvage MCS use in TAVR patients with CS are poor, with 1/3 of patients not surviving the hospitalization. Careful patient selection and a judicious use of salvage MCS in those patients is recommended.
Khan et al. (Wed,) studied this question.