A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic Stenosis: Prevalence, Management and Outcomes

Essa, Mohammed; Aneni, Ehimen; Bernardi, Cecilia; Fleming, James H.; Paredes, María Martínez; Frumento, Katherine Stemmer; Abdelmessih, Medhat; Sugeng, Lissa; Bellumkonda, Lavanya

doi:10.1016/j.cardfail.2019.07.143

Cited by 4 publications

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“…Severe aortic stenosis is common among elderly patients with a prevalence of 3.4% and associated with acute heart failure [ 1 2 3 ], cardiogenic shock and death [ 4 ]. In high-risk patients mortality without aortic valve replacement is around 50% within one year [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis

et al. 2021

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Background: This study aimed to evaluate the acute treatment of patients with severe aortic valve stenosis in Germany. Methods and Results: Three treatment strategies in 11,027 patients acutely admitted due to aortic valve stenosis were compared from 2014 until 2018 using German nationwide records: The annual number of transcatheter aortic valve replacement (TAVR) procedures (1,294 to 1,827) and balloon valvuloplasty (BV only) procedures (170 to 233) in patients acutely admitted increased, but surgical aortic valve replacement (SAVR) procedures decreased (426 to 316). In comparison to BV only patients (mean age 81.3; EuroSCORE 23.2) SAVR patients were younger and at lower logistic EuroSCORE (mean age 66.9; EuroSCORE 9.4). Patients treated with TAVR were at comparable age and operative risk (mean age 81.3; EuroSCORE 24.4) as those patients treated with BV only. Primary outcome was in-hospital mortality. Reimbursement was considered secondary outcome. After risk adjustment using multivariable logistic and linear regression analyses, SAVR (OR 0.26 [96%CI 0.16;0.45], p < 0.001) and TAVR (OR 0.38 [0.29;0.49], p < 0.001) were associated with lower risk for mortality compared to BV only. Compared to BV only, hospitalization costs of patients undergoing SAVR were reduced by €5,578 ([95%CI €8,023; €3,133], p < 0.001). TAVR procedures were associated with higher hospitalization costs than BV only (risk-adjusted difference €4,143 [€2,330; €5,926], p < 0.001). Conclusions: BV only was associated with a substantially increased risk of in-hospital mortality in acute patients. We conclude that a definitive aortic valve replacement should be preferred as primary treatment in patients with severe aortic valve stenosis causing an acute admission.

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Section: Introductionmentioning

confidence: 99%

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis

et al. 2021

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“…AS is the most common valvular heart disease with a high risk of mortality and morbidity which has an incidence of sudden cardiac death about 50% in symptomatic and 1% in asymptomatic severe AS. [5] In a systematic analysis by Essa, et al [6] it was found that 3.5% to 12% of individuals diagnosed with AS present with CS. Among these patients who underwent balloon aortic valvuloplasty (BAV) for CS, the in-hospital mortality varies between 43% and 77%.…”

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Is primary transcatheter aortic valve implantation the new normal?

Anantharaman,

Sundar,

Jena

et al. 2024

Journal of Geriatric Cardiology

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Rest, replace, and recover: TandemHeart to transcatheter aortic valve replacement—a case report

Haq,

Shah,

Eapen

et al. 2024

European Heart Journal - Case Reports

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Background Severe aortic stenosis (AS) can present insidiously, with the end stages resulting in significant valvular–induced cardiomyopathy and can lead to cardiogenic shock (CS). Such cases result in a myriad of complex manifestations and are often associated with a poor prognosis. These patients require emergent cardiac evaluation and valvular intervention. Unfortunately, the immediate nature of the CS provides little time for a detailed valvular evaluation. Possible management involves use of mechanical circulatory support (MCS) prior to urgent transcatheter aortic valve replacement (TAVR). Case summary The patient was a 70-year-old female who developed refractory CS, and acute decompensated heart failure was complicated by AV block secondary to severe AS. Due to progressively worsening haemodynamics, the need for MCS for cardiovascular support and eventual valve replacement resulted in the decision to pursue TandemHeart® (TH; LivaNova Inc, Pittsburgh, PA, USA). We discuss the novel implementation of the TH as a means of bridging to TAVR. Discussion TandemHeart system provides the benefits of improving haemodynamic support in CS while allowing unencumbered access to the stenotic valve for balloon aortic valvuloplasty (BAV) or TAVR. In our evaluation, we discuss the utilization and benefits associated with TH to TAVR in allowing for cardiac rest, replacement of the valve, and recovery of left ventricular function.

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A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic Stenosis: Prevalence, Management and Outcomes

Cited by 4 publications

References 0 publications

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis

Is primary transcatheter aortic valve implantation the new normal?

Rest, replace, and recover: TandemHeart to transcatheter aortic valve replacement—a case report

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