Does emergency transcatheter aortic valve replacement improve outcomes in patients with severe aortic stenosis and cardiogenic shock?
Emergency TAVR is a life-saving strategy for patients with severe aortic stenosis presenting with cardiogenic shock, requiring a streamlined door-to-valve pathway and careful procedural optimization.
Cardiogenic shock (CS) caused by severe aortic stenosis (AS) is an archetype of supply-demand mismatch in which increased left ventricular afterload, impaired coronary perfusion, and concentric hypertrophy, combine to cause multiorgan hypoperfusion. Early relief of valvular obstruction through emergency transcatheter aortic valve replacement (TAVR) or, in selected cases, balloon aortic valvuloplasty (BAV) as bridge therapy, can be life-saving. Although emergency TAVR demonstrates acceptable procedural success rates and survival compared with BAV alone, short-term mortality remains high due to shock severity, comorbidities, use of mechanical circulatory support (MCS), and procedural and logistical challenges. This review outlines current hemodynamic phenotypes of CS, a streamlined door-to-valve pathway, appropriate use of MCS, a framework for selecting emergency TAVR or BAV bridging, procedural management tailored to shock physiology, and predictors of clinical outcomes, providing evidence-based guidance to optimize rescue therapy in AS patients with CS.
Kitahara et al. (Fri,) studied this question.