Key result
Emergent TAVR in patients with severe aortic stenosis and cardiogenic shock or cardiac arrest resulted in 100% procedural success and 89% survival to discharge.
Why the study?
Does emergent TAVR improve survival and symptoms in patients with severe aortic stenosis presenting with cardiogenic shock or cardiac arrest?
Observational (n=9)
No
Does emergent TAVR improve survival and symptoms in patients with severe aortic stenosis presenting with cardiogenic shock or cardiac arrest?
Emergent TAVR appears to be a feasible and effective salvage therapy for patients with severe aortic stenosis presenting with cardiogenic shock or cardiac arrest.
Supports feasibility in refractory shock; leaves open need for prospective trials to guide selection and outcomes.
Background Patients with severe aortic stenosis (AS) often present acutely with decompensated heart failure, cardiogenic shock or cardiac arrest requiring immediate intervention. Transcatheter aortic valve replacement (TAVR) has been effectively utilized to treat such patients. However, data on emergent TAVR remain scarce. Methods We report a cases series of consecutive patients who underwent emergent TAVR between July 2016 and December 2017 at our institution. We describe the patients' characteristics, the rational for intervention, procedural details, and mid-term outcomes. Results Nine patients underwent emergent TAVR during the study's period. Mean age was 80.6 ± 9.9, 44% were males, mean left ventricular ejection fraction was 42.8 ± 19.1. The rational for emergent intervention was cardiogenic shock in 6 (67%), cardiac arrest in 2 (22%), and both in 1 (11%). Mean transaortic valve gradient was 49.8 ± 20.4 mmHg. The mean time from event to TAVR time was 9.9 hours (range 2–14). Balloon aortic valvuloplasty was utilized pre-TAVR in four patients (44%), and peri-procedural percutaneous assist devices were used in three patients (33%). Sapien S3 was the most used valve (89%). Procedural success was achieved in 100%, and 8/9 patients (89%) survived to discharge. All surviving patients were alive and in class I/II New York Heart Association (NYHA) symptom category both at 1 month and a mean follow-up of 8.4 ± 3.7 months. Conclusions TAVR may provide a feasible and effective treatment for patients with decompensated AS requiring emergent intervention. Further studies are needed to identify the optimal algorithm for the management of these patients.
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Alkhouli et al. (2018) conducted an observational in Severe aortic stenosis with cardiogenic shock or cardiac arrest (n=9). Emergent Transcatheter Aortic Valve Replacement (TAVR) was evaluated on Procedural success and survival to discharge. Emergent TAVR in patients with severe aortic stenosis and cardiogenic shock or cardiac arrest resulted in 100% procedural success and 89% survival to discharge.
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