Key result
Primary TAVI is the preferred strategy for cardiogenic shock complicating severe AS, alongside complementary BAV.
Why the study?
Management of CS in severe AS is clinically challenging, and decision-making remains heterogeneous and largely informed by observational evidence.
This review provides a pathway-oriented framework for managing cardiogenic shock in severe aortic stenosis, emphasizing early recognition and timely transcatheter valve intervention.
Early identification of medical non-responders with CS and severe AS may warrant prompt valve intervention; leaves open optimal strategies pending randomized data.
Management of cardiogenic shock (CS) in the setting of severe aortic stenosis (AS) remains clinically challenging, owing to the coexistence of fixed valvular obstruction, limited myocardial reserve, and rapidly evolving end-organ hypoperfusion. In this context, early identification of patients unlikely to recover with medical therapy alone and timely transition to definitive valve intervention are critical determinants of outcome. Despite growing clinical experience, decision-making in this setting remains heterogeneous and largely informed by observational evidence. Herein, in the present review, we synthesize contemporary evidence on transcatheter strategies for AS-related CS, with emphasis on clinical decision-making during the acute phase. A physiology-driven approach to early assessment and hemodynamic stabilization is outlined, integrating echocardiography, invasive monitoring, and tailored pharmacologic support to inform escalation pathways. Mechanical circulatory support (MCS) is discussed as a selective, time-limited strategy to achieve stabilization and facilitate procedural planning, while accounting for the unique physiological limitations imposed by fixed valvular obstruction. Available data on balloon aortic valvuloplasty and urgent or emergent transcatheter aortic valve implantation (TAVI) are examined with respect to procedural feasibility, early outcomes, and their positioning within bridging or definitive treatment pathways in CS. Collectively, this work proposes a pathway-oriented framework for AS-related CS that prioritizes early recognition, coordinated multidisciplinary decision-making, and timely progression to definitive valve intervention, tailored to patient risk profile and institutional expertise.
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Muro et al. (2026) conducted a review in Cardiogenic shock complicating severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) and Balloon aortic valvuloplasty (BAV) was evaluated. Primary transcatheter aortic valve implantation is the preferred strategy for cardiogenic shock complicating severe aortic stenosis when feasible, while balloon aortic valvuloplasty retains a complementary role.
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