Temporary Mechanical Support as a Bridge to Transcatheter Aortic Valve Replacement in Cardiogenic Shock

BACKGROUND: Cardiogenic shock in the setting of severe aortic stenosis or degenerated bioprosthetic valves is associated with high morbidity and mortality. Definitive valve intervention is often deferred due to profound hemodynamic instability and multiorgan dysfunction. Optimal strategies to stabilize these patients before transcatheter aortic valve replacement (TAVR) remain incompletely defined. CASE SUMMARY: We present a case series of 3 patients with cardiogenic shock due to severe aortic valve disease who were managed with temporary mechanical circulatory support (MCS) as a bridge to TAVR. Hemodynamic support strategies, including a transseptal left ventricular assist device or a transvalvular axial-flow device, were selected based on valve pathology, vascular access, and anticoagulation considerations. MCS facilitated hemodynamic stabilization, recovery of end-organ function, and successful valve intervention in all cases. DISCUSSION: These cases highlight the feasibility of individualized MCS strategies to stabilize patients with aortic stenosis-related cardiogenic shock, enabling safe TAVR and meaningful patient recovery. TAKE-HOME MESSAGES: Temporary mechanical circulatory support may serve as an effective bridge to TAVR in selected patients with cardiogenic shock due to severe aortic valve disease. Individualized device selection and multidisciplinary Heart Team collaboration are essential to achieving favorable outcomes.