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

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.