Emergent Transcatheter Aortic Valve Replacement Research Articles

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis.

Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR. We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software. A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group. Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.

Feasibility of emergent transcatheter aortic valve replacement sequentially followed by cardiac computed tomography angiography: experience from the procedure.

Feasibility of emergent transcatheter aortic valve replacement sequentially followed by cardiac computed tomography angiography: experience from the procedure.

When possible, try to avoid emergent transcatheter aortic valve replacement.

When possible, try to avoid emergent transcatheter aortic valve replacement.

Trends in invasive treatment of patients hospitalized with aortic stenosis complicated by cardiogenic shock.

Before the development of transcatheter aortic valve replacement (TAVR), balloon aortic valvuloplasty (BAV) was the only potential nonsurgical intervention for patients with aortic stenosis complicated by cardiogenic shock. Emergent TAVR is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for aortic stenosis and cardiogenic shock among patients received invasive intervention have shifted since TAVR was introduced. We used the Nationwide In patients Sample to identify nonelective hospitalizations for patient with aortic stenosis complicated by cardiogenic shock who received invasive treatment (TAVR, BAV, or surgical aortic valve replacement [SAVR]). We explored the proportion treated with each treatment modality over time, the patient characteristics and in-hospital mortality associated with each treatment, and used multivariable logistic regression to examine whether changes in in-hospital mortality over time differed by treatment. Between 2010 and 2019, we identified 9899 hospitalizations for decompensated aortic stenosis with cardiogenic shock during which patients received invasive treatment (TAVR 17.7%, BAV 20.2%, SAVR 62.1%). Use of both TAVR and BAV has increased over time compared with SAVR (TAVR 6.6% ≥ 33.8%, BAV 8.4% ≥ 23.2%, SAVR 91.6% ≥ 43.0%; p < 0.001 for trend). The overall in-hospital mortality rate was 21.0%, which decreased over time for all treatments (TAVR 20.0% ≥ 18.8%, BAV 66.0% ≥ 25.5%, SAVR 17.7% ≥ 11.8%; linear trend p < 0.001 for each), with lower mortality for TAVR versus BAV at all time points. Patients treated with TAVR (vs. BAV) were less likely to require mechanical ventilation (36.8% vs. 46.3%, p < 0.001) or mechanical circulatory support (22.5% vs. 29.9%, p < 0.001). In the multivariable analysis, the interaction between treatment and time was not significant (p = 0.245), indicating the reduction in in-hospital mortality over time did not differ among the treatments. Since the introduction of TAVR, there has been a shift toward increased use of nonsurgical invasive treatments (both BAV and TAVR) for aortic stenosis and cardiogenic shock. Although in-hospital mortality has declined, it remains high in all groups, but particularly among patients treated with BAV, where the severity of cardiogenic shock appears to be higher than in those treated with other modalities.

Preliminary evaluation on the efficacy of emergency transcatheter aortic valve replacement: a multicenter study

Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.

TAVR in patients with cardiogenic shock or severely decompensated aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Background Severe aortic stenosis (AS) can result in cardiogenic shock (CS) or severe cardiac decompensation. Although transcatheter aortic valve replacement (TAVR) is the routine procedure for elderly or inoperable patients with severe AS, its role as an emergency therapy for critically ill patients, especially due to CS, needs further investigation. Purpose The purpose of this study was to explore clinical characteristics and long-term survival of patients treated with emergency TAVR. We hypothesised that patients surviving the initial interventional and intensive care treatment would have a similar prognosis as elective TAVR patients. Methods All patients undergoing TAVR at our centre between 2013 and 2019 were screened for emergency TAVR or treatment on intensive care units (ICU) before TAVR. Selected patients were divided into groups with or without CS, defined as systolic blood pressure &amp;lt;90 mmHg or the use of inotropes and lactate &amp;gt;2 mmol/l. The remaining patients undergoing elective TAVR served as a comparison cohort. Results Out of 189 patients with emergency TAVR, 53 patients were in CS (shock group) and 136 patients did not fulfil CS criteria (urgent group). Patients in the shock group were more often male (75.5% vs. 56.6%, p=0.02), had a higher Society of Thoracic Surgeons score (15.6 [IQR, 7.7-30.5] vs. 5.4 [3.8-8.3], p&amp;lt;0.01), and lower left-ventricular ejection fraction (38.0% vs. 48.0%, p&amp;lt;0.01). The rate of coronary artery disease was similar (78.0% vs. 75.2%, p=0.69). Concerning the cause of acute decompensation, a specific condition which resulted in a clinical deterioration triggering hospitalisation could be identified in most patients. These included, among others, volume overload, acute coronary syndromes, arrhythmias, infections, and bleeding. Before TAVR, patients were treated on an ICU for 3 [2-5] days (shock group) and 2 [1-5] days (urgent group), p=0.01. In the shock group, mechanical ventilation was more frequent (52.8 vs. 14.7%, p&amp;lt;0.01), and more patients received valvuloplasty before TAVR (18.9 vs. 3.7%, p&amp;lt;0.01). The Valve Academic Research Consortium 3 (VARC-3) composite endpoint of technical failure occurred more often in emergency patients (shock, 13.2% vs. urgent, 9.6%) than in the 2,741 patients after elective TAVR (4.8%, p&amp;lt;0.01). Estimated 2-year mortality was higher in the shock compared to urgent group (hazard ratio, 2.1 [1.3-3.3], p&amp;lt;0.01). In a landmark analysis from day 90, 2-year mortality in these groups was comparable to elective TAVR patients (p=0.41, Figure). Conclusions TAVR in CS is associated with increased mortality compared to other cases of urgent TAVR. Procedural complication rates exceed those of elective TAVR patients. However, patients treated with emergency TAVR who survived 90 days after the procedure had a prognosis similar to elective TAVR patients.

Outcomes of emergency transcatheter aortic valve replacement in patients with cardiogenic shock: A multicenter retrospective study.

Rescue transcatheter aortic valve replacement (TAVR) in patients with cardiogenic shock is challenging, and there is limited literature on these critical patients. The aim of this study was to determine the characteristics and outcomes of patients undergoing TAVR, feasibility and safety of the procedure, and 1-year mortality factors. Thirty-eight patients with severe aortic disease and cardiogenic shock admitted to two French hospitals from 2015 to 2019 were included. The patients were critical, 78.9% of them had a left ventricular ejection fraction of <30%, and all of them received inotropic support. "Valve-in-valve" procedures were performed in 15.8% and 13.2% underwent balloon aortic valvuloplasty before TAVR. Edwards Sapien3® and Medtronic CoreValve EvolutR® were used. The survival probability remained reasonable for patients with cardiogenic shock who underwent rescue TAVR. The 30-day mortality rate was 7.9% and 21.1% at 1 year. No patient died during the intervention. The procedure was safe, with few complications except for acute kidney failure, the development of a left bundle branch block, and the need for pacemaker implantation. Both functional and echocardiographic results were good at 1 year, although 29% of the patients underwent rehospitalization within 1 year. The development of a left bundle branch block was found to be a mortality risk factor. This procedure is a safe and effective therapy with acceptable survivorship in critically ill patients. The benefits to their quality of life should be evaluated in future studies, and the need for providing early cardiac resynchronization therapy must be emphasized.

Abstract 11210: Trends in Invasive Treatment of Patients Hospitalized with Acute Decompensated Aortic Stenosis and Cardiogenic Shock

Background: Prior to 2012, balloon aortic valvuloplasty (BAV) was the only potential intervention for patients with decompensated aortic stenosis (AS) and cardiogenic shock. Emergent transcatheter aortic valve replacement (TAVR) is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for AS and cardiogenic shock have shifted since TAVR was introduced. Methods: We identified hospitalizations of patients with AS and cardiogenic shock within the National Readmissions Database, the proportion treated with BAV or TAVR, and in-hospital mortality over the study period by treatment. Due to challenges in determining the timing of surgery vs. onset of shock, patients who underwent surgical AVR were excluded. Results: From 2010-2018, there were 17,297 hospitalizations for AS and cardiogenic shock, which have increased over time (Figure A legend). The proportion of hospitalizations where either BAV or TAVR was used has also increased (BAV 3.9%-&gt;7.1%; TAVR 3.8%-&gt;10.1%; Figure A). In-hospital mortality was very high but has significantly decreased over time for all treatment strategies (no invasive: 46.9%-&gt;35.5%; BAV: 45.7%-&gt;34.2%; TAVR 18.8%-&gt;8.9%; Figure B), with much lower mortality rates the TAVR group at all time points. Compared with BAV, patients treated with TAVR were less likely to require mechanical ventilation (TAVR 34.6% vs BAV 49.1%) or mechanical circulatory support (TAVR 19.9% vs BAV 30.6%; p&lt;0.001 for both). Age and comorbidity burden were similar among groups. Conclusions: Over the past decade, hospitalizations for AS and cardiogenic shock have increased as has the proportion in which BAV or TAVR are emergently used. Although in-hospital mortality has declined over time, it remains very high, particularly among patients treated with BAV or those without intervention. This is likely in part due to the lower severity of cardiogenic shock of the patients treated with TAVR.

TCT-413 Outcomes of Adults With Severe Aortic Stenosis Undergoing Elective Versus Urgent or Emergent Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System

TCT-413 Outcomes of Adults With Severe Aortic Stenosis Undergoing Elective Versus Urgent or Emergent Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System

Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus.

The purpose of this study was to evaluate tip-to-base intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON) in patients undergoing transcatheter mitral valve replacement (TMVR) in annuloplasty rings or surgical mitral valves. LAMPOON is an effective adjunct to TMVR that prevents left ventricular outflow tract obstruction (LVOTO). Laceration is typically performed from the base to the tip of the anterior mitral leaflet. A modified laceration technique from leaflet tip to base may be effective in patients with a prosthesis that protects the aortomitral curtain. This is a multicenter, 21-patient, consecutive retrospective observational cohort. Patients underwent tip-to-base LAMPOON to prevent LVOTO and leaflet overhang, or therapeutically to lacerate a long anterior mitral leaflet risking or causing LVOTO. Outcomes were compared with findings from patients in the LAMPOON investigational device exemption trial with a prior mitral annuloplasty. Twenty-one patients with a annuloplasty or valve prosthesis-protected mitral annulus underwent tip-to-base LAMPOON (19 preventive, 2 rescue). Leaflet laceration was successful in all and successfully prevented or treated LVOTO in all patients. No patients had significant LVOTO upon discharge. There were 2 cases of unintentional aortic valve injury (1 patient underwent emergency transcatheter aortic valve replacement and 1 patient underwent urgent surgical aortic valve replacement). In both cases, the patients had a supra-annular ring annuloplasty, and the retrograde aortic guiding catheter failed to insulate the guidewire lacerating surface from the aortic root. All patients survived to 30days. Compared with classic retrograde LAMPOON, there was a trend toward shorter procedure time. Tip-to-base laceration is a simple, effective, and safe LAMPOON variant applicable to patients with an appropriately positioned mitral annular ring or bioprosthetic valve. Operators should take care to insulate the lacerating surface from adjacent structures.

Abstract 12999: Correcting the Current: Modeling the Hemodynamic Impact of Transcatheter Aortic Valve Replacement in Multiple Valvular Heart Disease Precipitating Cardiogenic Shock

Introduction: Multiple valvular heart disease (mVHD) caused by mixed stenotic and regurgitant lesions involving at least two valves is a common condition which is poorly understood and challenging to manage. Herein, we simulate the hemodynamics of a patient with mVHD before and after transcatheter aortic valve replacement (TAVR) to better understand the physiology of this complex disease. Case: A 67-year-old man with celiac enteropathy presented to a local hospital with dyspnea, hypotension, and oliguria. Echocardiography revealed a dilated left ventricle (end-diastolic diameter [LVEDD] 6.7 cm) with an ejection fraction (EF) of 20% and multiple severe valvulopathies, including aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). Right heart catheterization revealed a low cardiac index (1.76 L/min/m 2 ) and a high wedge pressure (36 mmHg) with V-waves exceeding 50 mmHg. The patient’s severe AR precluded mechanical circulatory support, so TAVR was emergently performed in the setting of worsening cardiogenic shock (CS) with a 29 mm self-expanding bioprosthesis via transfemoral access. Valve deployment was successfully guided by fluoroscopy and transthoracic echocardiography alone. CS resolved in the subsequent 48 hours, and at 3-month follow-up, his LV EF returned to 55% and LVEDD decreased to 4.4 cm. LV pressure-volume loops pre- and post-TAVR were generated using a cardiovascular physiology simulator (Fig. 1). TAVR’s correction of the patient’s severe AS and AR produced immediate energetic benefits, with pressure-volume area declining 13% and cardiac power output increasing 2.24-fold. Conclusions: This challenging case and the accompanying pressure-volume analysis affirms the feasibility of emergent TAVR in highly selected patients, the procedure’s ability to immediately improve ventricular performance, and the LV’s capacity to remodel when operating under more physiologic loading conditions.

889 Stretching the Limits of Transcatheter Aortic Valve Replacement (TAVR): Emergency TAVR Deployment Using Leaflet Calcification for Neo-Annulus Construction in an Extremely Large Aortic Annulus

A 73-year-old previously healthy man, presented with cardiogenic shock and ventricular tachycardia (VT) storm due to critical aortic stenosis (mean invasive gradient of 84 mm Hg across the aortic valve) with moderate aortic incompetence (AI) causing severe left ventricular dysfunction (ejection fraction 10%), underwent transcatheter aortic valve replacement (TAVR) within 3 hours of review by TAVR team. Urgent CT demonstrated a type 1 bicuspid aortic valve with an extremely large aortic annulus exceeding the maximum dimensions for all TAVR bioprostheses (area 988 mm2, perimeter 112.3 mm, minimum and maximum diameter of 33 mm and 38 mm respectively, LVOT diameter 29 mm) and extreme calcification of the valve leaflets. An urgent TAVR proceeded with a 29 mm self-expanding bioprosthesis (Abbott Portico Self-Expanding Valve). The dense, cauliflower-like leaflet calcification was used to anchor the prosthesis in a high position creating a neo-annulus from the valve tissue, modifying a technique that has been described for the management of type 0 bicuspid valves with a fibrotic ovoid orifice. Following deployment, initial significant prosthesis constraint with moderate paravalvular leak (PVL) with two main jets were noted on transesophageal echo. Multiple post-dilatations using an overfilled 28 mm Nucleus-X balloon were performed. The AI index at the end of the procedure was 0.41 indicating mild PVL. LVEF improved to 30%, 1-week post-TAVR. This case highlights that emergency TAVR can be life-saving in a challenging anatomy, illustrating a strategy of creating a high neo-annulus using extreme leaflet calcification where the true native annulus size exceeds current device capabilities.

Outcomes of Emergency Transcatheter Aortic Valve Replacement.

Objective To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality. Background Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited. Methods All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018. Results 31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%, p=0.01), intraprocedural cardiopulmonary resuscitation (CPR) (83.3% vs 4.0%, p ≤ 0.001), acute kidney injury post-TAVR (80.0% vs. 4.2%, p ≤ 0.001), initiation of dialysis post-TAVR (60.0% vs. 4.2%, p ≤ 0.001), and MCS initiation post-TAVR (50.0% vs. 12.0%, p=0.03). MCS initiation before TAVR was associated with improved survival compared with post-TAVR initiation. Conclusion Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.

Emergent Transcatheter Aortic Valve Replacement for the Treatment of Severe Aortic Stenosis Patients Presenting With Cardiogenic Shock or Cardiac Arrest; A Case Series

ABSTRACT Background: Patients with severe aortic stenosis (AS) often present acutely with decompensated heart failure, cardiogenic shock or cardiac arrest requiring immediate intervention. Transcatheter aortic valve replacement (TAVR) has been effectively utilized to treat such patients. However, data on emergent TAVR remain scarce. Methods: We report a cases series of consecutive patients who underwent emergent TAVR between July 2016 and December 2017 at our institution. We describe the patients’ characteristics, the rational for intervention, procedural details, and mid-term outcomes. Results: Nine patients underwent emergent TAVR during the study’s period. Mean age was 80.6 ± 9.9, 44% were males, mean left ventricular ejection fraction was 42.8 ± 19.1. The rational for emergent intervention was cardiogenic shock in 6 (67%), cardiac arrest in 2 (22%), and both in 1 (11%). Mean transaortic valve gradient was 49.8 ± 20.4 mmHg. The mean time from event to TAVR time was 9.9 hours (range 2–14). Balloon aortic valvuloplasty was utilized pre-TAVR in four patients (44%), and peri-procedural percutaneous assist devices were used in three patients (33%). Sapien S3 was the most used valve (89%). Procedural success was achieved in 100%, and 8/9 patients (89%) survived to discharge. All surviving patients were alive and in class I/II New York Heart Association (NYHA) symptom category both at 1 month and a mean follow-up of 8.4 ± 3.7 months. Conclusions: TAVR may provide a feasible and effective treatment for patients with decompensated AS requiring emergent intervention. Further studies are needed to identify the optimal algorithm for the management of these patients.

TCT-100 Emergency TAVR for Cardiogenic Shock—right heart function and early mechanical circulatory support improve outcomes

Transcatheter aortic valve replacement (TAVR) has been established as a safe and effective option for patients who are at prohibitive or high risk for surgery. The role of emergent TAVR as rescue therapy in cardiogenic shock, however, has not been widely studied. Patients undergoing emergent TAVR

Emergency transcatheter aortic valve replacement for a patient with decompensated severe aortic stenosis accompanied by cardiorenal syndrome: a case report

BackgroundSevere aortic stenosis (AS) may lead to acute decompensated heart failure resistant to medical treatment. Here, we report a successful emergent transcatheter aortic valve replacement (TAVR) in a patient presenting with decompensated severe AS accompanied by cardiorenal syndrome.Case presentationA 82-year-old man presented at our emergency department with aggravated dyspnea. His chest X-ray showed bilateral pulmonary edema, and laboratory examination revealed acute kidney injury. Transthoracic echocardiography (TTE) revealed low-flow, low-gradient AS with decreased left ventricular systolic function. With a diagnosis of acute decompensated heart failure combined with cardiorenal syndrome, we opted to perform emergent TAVR. Ultimately, we successfully performed emergent TAVR using only TTE and 3-D transesophageal echocardiography (TEE) measurements.ConclusionsThis report presents a case of decompensated severe AS accompanied by cardiorenal syndrome that was treated successfully with emergent TAVR. Thus, emergent TAVR using only echocardiography measurements is a feasible and safe option for treating decompensated heart failure accompanied by cardiorenal syndrome the clinical setting.

EMERGENT ECHOCARDIOGRAPHY-GUIDED TRANSCATHETER AORTIC VALVE REPLACEMENT IN A SEVERE AORTIC STENOSIS PATIENT PRESENTING WITH CARDIAC ARREST

Patients with severe aortic stenosis presenting with cardiac arrest and cardiogenic shock may not be offered transcatheter aortic valve replacement (TAVR) due to the substantial morbidity and mortality of emergent TAVR. 69-year-old male with aortic stenosis, hypertension, and hyperlipidemia

Emergency Transcatheter Aortic Valve Replacement Versus Balloon Aortic Valvuloplasty for the Management of Decompensated Aortic Stenosis

Emergency Transcatheter Aortic Valve Replacement Versus Balloon Aortic Valvuloplasty for the Management of Decompensated Aortic Stenosis

Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis.

To assess outcomes of TAVR as a rescue therapy in patients with cardiogenic shock due to acutely decompensated aortic stenosis. Of 771 high-risk patients who underwent TAVR, 27 (3.5%; 78±9 years; 12 men) were treated emergently due to acutely decompensated aortic stenosis with cardiogenic shock. SAPIEN and CoreValve prostheses were implanted in 11 and 16 patients, respectively: the transfemoral access route was used in 25. Three patients died within 72 hours of successful valve deployment, and a further six died within a month, giving a 30-day mortality of 33.3%, which was significantly higher than in electively treated patients (7.7%, p<0.0001). Univariate predictors of 30-day mortality in cardiogenic-shock patients were baseline cardiac output <3.0 l/min, reduced cardiac power index, impaired renal function, and mechanical ventilation, as well as severe acute kidney injury after TAVR. Estimated one-year survival was 59.3% in emergently and 82.7% in electively treated patients (p=0.0009). However, 30-day landmark analysis showed no difference in cumulative survival between TAVR modalities. In cardiogenic-shock patients without concomitant reduced cardiac output and impaired renal function at baseline (n=22), estimated one-year survival was 72.7%. TAVR should be considered a reasonable rescue therapy in patients with cardiogenic shock secondary to decompensated aortic stenosis.

Transcatheter aortic valve replacement for patients with heart failure.

Older patients suffering severe heart failure related to aortic stenosis (AS) undergo transcatheter aortic valve replacement (TAVR), owing to their high surgical risk. The diagnosis is made based on echocardiographic examination, but may require a multimodality imaging approach in patients with low gradients. In severely decompensated heart failure or cardiogenic shock, rescue percutaneous balloon aortic valvuloplasty as a bridge to TAVR seems reasonable. Emergent TAVR has been reported. Efforts should be made to avoid late diagnosis or referring patients with severe AS to offer them timely interventions, reduce the risk of TAVR, and predict whether left ventricular function will improve.