Cardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry

Abstract

Data on cardiogenic shock (CS) in adults with congenital heart disease (ACHD) are scarce. We sought to describe CS in ACHD in a nationwide CS registry. From the multicentric FRENSHOCK registry (n = 772 CS from 49 French centers between April and October 2016), ACHD CS were compared with non-ACHD ones. The primary outcome was defined by all-cause mortality, chronic ventricular assist device (VAD) or heart transplantation at 1-year. Out of the 772 patients, 7 (1%) were ACHD. ACHD patients were younger (54 vs. 66 years old), with less cardiovascular risk factors, such as hypertension (14.2 vs. 47.5%) and diabetes (14.3 vs. 36.1%), and no ischemic cardiopathy (0 vs. 61.5%). Right heart catheterization (57.1 vs. 15.4%), pacemaker (28.6 vs. 4.6%) and ICD (28.6 vs. 4.8%) were more frequently indicated in the ACHD CS management compared to non-ACHD CS, whereas temporary MCS (0 vs. 7.2%) and invasive mechanical ventilation (14.3 vs. 38.1%) were less likely used in ACHD. At 1-year, primary outcome occurred in 85.7% ACHD and 52.2% non-ACHD (P = 0.127) (Fig. 1). Although 1-year mortality was similar (45.4 vs. 42.9% respectively for ACHD and non-ACHD patients, P = 1), VAD (14.3 vs. 5.4%, P = 0.325), and heart transplantation (28.6 vs. 5.2%, P = 0.05) seemed more frequent in ACHD group. CS in ACHD is rare accounting for only 1% of an unselected CS population. Despite a younger age and less comorbidities its prognosis remains severe and similar to others patients.