The mortality of patients with severe aortic stenosis (SAS) and cardiogenic shock (CS) is exceedingly high. Information on the results of transcatheter aortic valve replacement (TAVR) in patients with SAS and CS is limited. The aim of this study was to assess the results of TAVR compared to surgical aortic valve replacement (SAVR) or medical treatment (MT) in patients with SAS and CS. Retrospective observational study including patients with ≥18 years of age, admitted to tertiary care hospitals (with Cardiovascular Surgery Department) with diagnosis of SAS and CS from 2016 to 2022. Patients were classified in three categories as they were treated with TAVR, SAVR or MT. The main outcome of the study was in-hospital mortality. A total of 431 patients were finally included in the study: 107 (24.8%) in the TAVR-group, 64 (14.8%) in the SAVR-group and 260 (60.3%) in the MT-group. In-hospital mortality was 46.6%. Patients in the TAVR-group had a significantly lower mortality (20.6%), compared to the SAVR-group (32.8%) and the MT-group (60.8%) (p<0.001, respectively). Multivariate logistic regression analysis showed that TAVR (OR 0.14, p<0.001) and SAVR (OR 0.26, p<0.001) were independently associated with a reduced risk of mortality. Acute kidney injury, need for pacemaker stimulation and mechanical circulatory support (MCS) resulted independently associated with a worse prognosis. Patients with SAS in CS have an extreme mortality risk. TAVR was associated with a lower mortality risk, compared to SAVR and MT. Acute kidney injury, the need for pacemakers and MCS were independently associated with a higher mortality.
Ferrera et al. (Fri,) studied this question.