VA-ECMO as a bridge to TAVR/SAVR in AVD-CS patients resulted in 30- and 180-day survival rates of 96.7% and 90.3%, with improved lactate and LVEF up to 45%.
Does VA-ECMO provide hemodynamic stabilization and improve survival as a bridge to TAVR/SAVR in patients with cardiogenic shock associated with severe aortic valve dysfunction?
VA-ECMO provides effective hemodynamic stabilization and high survival rates as a bridge to TAVR or SAVR in patients with cardiogenic shock due to severe aortic valve dysfunction.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Cardiogenic shock due to severe aortic valve dysfunction (AVD-CS) from aortic stenosis (AS) or aortic insufficiency (AI) is associated with high mortality. Surgical (SAVR) or transcatheter aortic valve replacement (TAVR) are the only curative treatments, but AVD-CS patients undergoing these procedures have worse outcomes and lower survival due to hemodynamic instability and multi-organ failure when compared to patients without shock. These risks may discourage offering TAVR or SAVR to AVD-CS patients, particularly when adverse outcomes are classified as procedure-related complications. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a potential bridge therapy for stabilizing AVD-CS patients before definitive valve intervention, though supporting evidence remains scarce. Purpose To evaluate the role of VA-ECMO as a bridge to TAVR/SAVR in AVD-CS patients with severe AS or AI. Methods We conducted a retrospective multicenter case series of AVD-CS cases receiving V A-ECMO before TAVR/SAVR, including clinical, imaging, and procedural data. These cases were combined with published case reports from PubMed/Medline from inception to January 2025. Results A total of 31 cases (13 from our institutions, 18 from literature) were included. The mean age was 61.2 years ±14.8, with 26% female patients. AS was the most common pathology (67%), followed by AI (26%) and mixed AS/AI (7%). Prior prosthetic valves were present in 29%, from which 13% developed severe bioprosthetic AS, 10% AI and 7% mixed AS/AI. Most patients had advanced cardiogenic shock (SCAI Stage D/E: 71%) and impaired hemodynamics (median PCWP 35, CI 1.5, lactate 5.1), requiring vasoactive support and other critical care therapies (table 1). The primary cause of decompensation was valvular disease progression (29.2%), followed by acute coronary syndrome (25.8%). The mean time from admission to ECMO initiation was 2.8 ± 1.8 days, ECMO to TAVR/SAVR was 2.4 ± 1.5 days, and total ECMO duration was 4.6 ± 3.3 days. A total of 26 TAVR and 5 SAVR procedures were performed, with 19.3% receiving intra-aortic balloon pump (IABP) and 22.6% requiring left atrial veno-arterial (LAVA ECMO). Survival rates at 30 and 180 days were 96.7% and 90.3%, respectively. Lactate levels improved significantly post-ECMO and post-TAVR/SAVR and left ventricular ejection fraction increased from 24.6% at baseline to 45% in 180 days (Figure). Conclusion VA-ECMO can facilitate management of AVD-CS patients and provide hemodynamic and clinical stabilization as a bridge therapy to TAVR/SAVR with potential beneficial outcomes. This study represents the most comprehensive series to date on this approach. Further prospective studies are needed to systematically evaluate its efficacy.Table Flow Chart
Martin et al. (Sat,) reported a other. VA-ECMO as a bridge to TAVR/SAVR in AVD-CS patients resulted in 30- and 180-day survival rates of 96.7% and 90.3%, with improved lactate and LVEF up to 45%.