SOLACI | Latin American Society of Interventional Cardiology

Patients presenting aortic stenosis with cardiogenic shock are at extreme risk, with 70% mortality until the aortic obstruction is resolved, and taking into account they make poor transplant candidates. Safety and efficacy of TAVR in patients with cardiogenic shock remains unclear.

The aim of this study was to assess events in patients undergoing TAVR with balloon expandable valves (SAPIEN 3 and SAPIEN 3 Ultra).

Populations were matched with propensity score. Primary end point was inhospital all-cause mortality, at 30 days and one year, and major complications in the same period of time.

Data from 4952 patients with cardiogenic shock were obtained. Mean age was 75.6 year with mean ejection fraction of 39.9%. observed complications were annulus rupture in 0.3%, aortic dissection in 0.2%, 0.4% coronary obstruction, 1% cardiac perforation, 0.2% devise embolization and 0.7% conversion to open surgery.

Compared against the matched cohort with no cardiogenic shock, there was more inhospital mortality (9.9% vs 2.7%, P<0.0001), stroke (2.9% vs 1.5%; P<0.0001), vascular complications (2.3% vs 1.3%, P<0.0001) and major bleeding (2.5% vs 0.7%, P<0.0001).

At one year, were was 29.7% mortality vs 22.6% in patients with no cardiogenic shock (HR 1.57, CI 95% 1.43-1.72, P<0.001). After multivariable analysis, predictors of mortality at 30 days were dialysis, pacemaker implantation, assisting device requirement, and peripheral vascular disease.

The author concluded that TAVR was effective and safe in the context of cardiogenic shock with acceptable events at 30 days and one year. These outcomes observed in a registry should suggest “primary” TAVR as the best strategy for patients with aortic stenosis leading to cardiogenic shock.