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

Abstract

Objective: The objective of this study was to summarize the prevalence and the available management strategies for cardiogenic shock in the setting of severe aortic stenosis and their outcome. Introduction: Aortic stenosis (AS) is the most common valvular heart disease in older adults. Cardiogenic shock (CS) is a medical emergency, and while management for these two conditions has evolved over the years, little is known about the prevalence, management, and mortality of AS in combination with CS. Methods: We performed a systematic review to identify studies that included patients with severe AS presenting with CS using EMBASE, MEDLINE, and Scopus. Primary outcomes included in-hospital, 30-day, and 1-year mortality. Additional outcomes included procedure-related complications. We registered the study protocol at PROSPERO (CRD42018112245). Results: We included a total of 10 studies representing 338 patients. In-hospital mortality ranged from 43% to 77% in patients treated with Balloon Aortic Valvuloplasty (BAV), 0% in patients who underwent surgical valve replacement (SAVR), and 11% and Transcatheter aortic valve replacement (TAVR). In patients undergoing BAV, 30-day mortality varied between 50% and 55%, and between 19% and 33% in those treated with TAVR. There was limited evidence on the use of Mechanical Circulatory Support (MCS). Conclusion: AS presenting with CS is a rare but fatal condition, and no consensus exists regarding management strategy. Time to intervention on the valve is critical. Valve replacement through either SAVR or TAVR had better outcomes compared to BAV alone. There is limited evidence on MCS as a management strategy in patients with AS complicated by CS.