Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese · 2025
Treatment of severe aortic stenosis and cardiogenic shock: outcomes of TAVR vs SAVR and medical therapy.
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Ferrera Carlos, Espejo-Paeres Carolina, Jiménez-Quevedo Pilar, Prado Náyade Del, Nombela-Franco Luis, Fernández-Pérez Cristina, Noriega Francisco Javier, Rosillo Nicolás, Gonzalo Nieves, Fernández-Jiménez Rodrigo, Núñez-Gil Iván Javier, Bernal José Luis, Pérez Pablo, Escaned Javier, Fernández-Ortiz Antonio, Elola Francisco Javier, Viana-Tejedor Ana
Аннотация
OBJECTIVE: The mortality of patients with severe aortic stenosis (SAS) and cardiogenic shock (CS) is exceedingly high. Information on the results of transcatheter aortic valve replacement (TAVR) in patients with SAS and CS is limited. The aim of this study was to assess the results of TAVR compared with surgical aortic valve replacement (SAVR) or medical treatment (MT) in patients with SAS and CS.
METHODS: Retrospective observational study including patients with ≥18 years of age, admitted to tertiary care hospitals (with a Cardiovascular Surgery Department) with diagnoses of SAS and CS from 2016 to 2022. Patients were classified in three categories because they were treated with TAVR, SAVR, or MT. The main outcome of the study was in-hospital mortality.
RESULTS: A total of 431 patients were finally included in the study: 107 (24.8%) in the TAVR group, 64 (14.8%) in the SAVR group, and 260 (60.3%) in the MT group. In-hospital mortality was 46.6%. Patients in the TAVR group had a significantly lower mortality (20.6%) than the SAVR group (32.8%) and the MT group (60.8%) (p < 0.001, respectively). The multivariate logistic regression analysis showed that TAVR (OR 0.14, p < 0.001) and SAVR (OR 0.26, p < 0.001) were independently associated with a reduced risk of mortality. Acute kidney injury, need for pacemaker stimulation, and mechanical circulatory support (MCS) were independently associated with a worse prognosis.
CONCLUSION: Patients with SAS in CS have an extreme mortality risk. TAVR was associated with a lower mortality risk than SAVR and MT. Acute kidney injury, the need for pacemakers, and MCS were independently associated with a higher mortality.
METHODS: Retrospective observational study including patients with ≥18 years of age, admitted to tertiary care hospitals (with a Cardiovascular Surgery Department) with diagnoses of SAS and CS from 2016 to 2022. Patients were classified in three categories because they were treated with TAVR, SAVR, or MT. The main outcome of the study was in-hospital mortality.
RESULTS: A total of 431 patients were finally included in the study: 107 (24.8%) in the TAVR group, 64 (14.8%) in the SAVR group, and 260 (60.3%) in the MT group. In-hospital mortality was 46.6%. Patients in the TAVR group had a significantly lower mortality (20.6%) than the SAVR group (32.8%) and the MT group (60.8%) (p < 0.001, respectively). The multivariate logistic regression analysis showed that TAVR (OR 0.14, p < 0.001) and SAVR (OR 0.26, p < 0.001) were independently associated with a reduced risk of mortality. Acute kidney injury, need for pacemaker stimulation, and mechanical circulatory support (MCS) were independently associated with a worse prognosis.
CONCLUSION: Patients with SAS in CS have an extreme mortality risk. TAVR was associated with a lower mortality risk than SAVR and MT. Acute kidney injury, the need for pacemakers, and MCS were independently associated with a higher mortality.