Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis
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Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis. / Frerker, Christian; Schewel, Jury; Schlüter, Michael; Schewel, Dimitry; Ramadan, Hassan; Schmidt, Tobias; Thielsen, Thomas; Kreidel, Felix; Schlingloff, Friederike; Bader, Ralf; Wohlmuth, Peter; Schäfer, Ulrich; Kuck, Karl-Heinz.
in: EUROINTERVENTION, Jahrgang 11, Nr. 13, 20.04.2016, S. 1530-1536.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis
AU - Frerker, Christian
AU - Schewel, Jury
AU - Schlüter, Michael
AU - Schewel, Dimitry
AU - Ramadan, Hassan
AU - Schmidt, Tobias
AU - Thielsen, Thomas
AU - Kreidel, Felix
AU - Schlingloff, Friederike
AU - Bader, Ralf
AU - Wohlmuth, Peter
AU - Schäfer, Ulrich
AU - Kuck, Karl-Heinz
PY - 2016/4/20
Y1 - 2016/4/20
N2 - AIMS: To assess outcomes of TAVR as a rescue therapy in patients with cardiogenic shock due to acutely decompensated aortic stenosis.METHODS AND RESULTS: 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%.CONCLUSIONS: TAVR should be considered a reasonable rescue therapy in patients with cardiogenic shock secondary to decompensated aortic stenosis.
AB - AIMS: To assess outcomes of TAVR as a rescue therapy in patients with cardiogenic shock due to acutely decompensated aortic stenosis.METHODS AND RESULTS: 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%.CONCLUSIONS: TAVR should be considered a reasonable rescue therapy in patients with cardiogenic shock secondary to decompensated aortic stenosis.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve Stenosis/surgery
KW - Cardiac Catheterization/methods
KW - Female
KW - Heart Valve Prosthesis/adverse effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Risk Factors
KW - Shock, Cardiogenic/surgery
KW - Transcatheter Aortic Valve Replacement/methods
KW - Treatment Outcome
U2 - 10.4244/EIJY15M03_03
DO - 10.4244/EIJY15M03_03
M3 - SCORING: Journal article
C2 - 25751886
VL - 11
SP - 1530
EP - 1536
JO - EUROINTERVENTION
JF - EUROINTERVENTION
SN - 1774-024X
IS - 13
ER -