Management of Severe Aortic Stenosis in Cardiogenic Shock: Early Percutaneous Mechanical Circulatory Support or Emergent Transcatheter Aortic Valve Replacement?
Aortic stenosis (AS) affects an estimated 1.5 million patients in the United States, with 250,000 patients or more suffering severe, symptomatic aortic stenosis. A subset of these patients also have unrevascularized coronary artery disease and left ventricular dysfunction, representing an extreme risk population of AS patients. Cardiogenic shock (CS) complicates a small minority of AS presentations and/or patients referred for transcatheter aortic valve replacement (TAVR) but is responsible in these cases for a disproportionately high rate of morbidity and mortality. Indeed, CS results in a 4-fold increase in TAVR mortality, proportional to shock severity and largely independent of procedural complications. All patients undergoing TAVR should undergo an assessment of hemodynamics and vascular access as well as an estimation of risk for conduction system abnormalities, coronary occlusion, landing zone rupture, and stroke. In patients with pre-procedural CS or at a high risk of hemodynamic deterioration, preemptive or carefully planned, provisional use of mechanical circulatory support (MCS) helps ensure the best possible outcomes during TAVR.
"Management of Severe Aortic Stenosis in Cardiogenic Shock: Early Percutaneous Mechanical Circulatory Support or Emergent Transcatheter Aortic Valve Replacement?,"
Journal of Shock and Hemodynamics: Vol. 1(1)
Available at: https://digitalcommons.library.tmc.edu/josh/vol1/iss1/8