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

Abstract

Background Cardiogenic shock (CS) management has evolved over the recent years especially after the development of mechanical circulatory support devices (MCS). Aortic stenosis (AS) is the most common valvular heart disease, yet little is known about the prevalence, management, and mortality of the AS and CS combination. Methods A systematic search was conducted to identify studies that included patients with combined AS and CS using EMBASE, MEDLINE, and Scopus. Primary outcomes included in-hospital, 30-day, and 1-year mortality. Additional outcomes included procedure-related complications. The study protocol was registered at PROSPERO (CRD42018112245). Results A total of 10 studies representing 338 patients were included. Prevalence of AS presenting with CS ranged from 3.5% to 12%. In-hospital mortality ranged from 43% to 77% in patients treated with Balloon Aortic Valvuloplasty (BAV), 0% and 11% in patients who underwent surgical valve replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) respectively. In patients undergoing BAV, 30-day mortality varied between 50% and 55%, and between 19% and 33% in those treated with TAVR. Delaying valve intervention for more than 48 hours was found to negatively impact survival after BAV. There was limited evidence on the use of Mechanical Circulatory Support (MCS). Conclusion AS presenting with CS is a fatal condition with no clarity of 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.