Comparing Direct TAVR to Balloon Aortic Valvuloplasty-TAVR in Patient with Cardiogenic Shock and Severe Aortic Stenosis—A TriNetX—Based Study

Aim: Severe aortic stenosis (AS) with cardiogenic shock (CS) presents a complex clinical challenge. For these patients, the optimal management strategy- either direct transcatheter aortic valve replacement (TAVR) or a staged approach with balloon aortic valvuloplasty (BAV) as a bridge to TAVR (BAV-TAVR) is uncertain. We aimed to compare the outcomes of these two strategies. Methods: We conducted a retrospective cohort study using TriNetX database. In this study, we identified patients with CS undergoing TAVR or BAV-TAVR. After matching propensity scores, 198 patients were analyzed in each group (total 396). The primary outcome was major adverse cardiovascular events (MACE) at 30 days, 1 year, and 3 years. Results: The analysis included 396 matched patients (198 in each cohort). There was no significant difference in the primary endpoint of MACE at 30 days between the staged BAV and direct TAVR groups (HR 1.14; 95% CI 0.79–1.64; p=0.91), and this finding was consistent at 1 and 3 years with HR 1.20 and 1.17 respectively. Similarly, no differences were observed in secondary outcomes including all-cause mortality, stroke, and new permanent pacemaker implantation, at 30 days, 1, and 3 years. Conclusion: For patients with severe AS complicated by CS, a staged strategy of using BAV-TAVR resulted in comparable short and long-term outcomes to direct TAVR. These findings suggest that BAV is a viable and safe bridging option in high-risk patients whose immediate candidacy for definitive therapy is uncertain.