Author + information
- Received September 4, 2019
- Revision received February 18, 2020
- Accepted February 25, 2020
- Published online June 1, 2020.
- Luke Masha, MD, MPHa,∗ (, )@lukemasha,
- Sreekanth Vemulapalli, MDb,
- Pratik Manandhar, MSc,
- Prakash Balan, MDd,
- Pinak Shah, MDe,
- Andrzej S. Kosinski, PhDc and
- Garrick Stewart, MDe
- aDivision of Cardiovascular Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon
- bDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- cDuke Clinical Research Institute, Durham, North Carolina
- dDivision of Cardiology, Department of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
- eDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Luke Masha, Oregon Health & Science University, Mailing code: UHN62, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239.
Objectives This paper details trends and outcomes in U.S. patients undergoing transcatheter aortic valve replacement (TAVR) who present pre-procedurally with cardiogenic shock.
Background Demographic, procedural characteristics, and clinical outcomes in U.S. patients undergoing TAVR after presenting with cardiogenic shock are unknown.
Methods The STS/ACC TVT (Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy) registry linked with Centers for Medicare & Medicaid Services claims data was used to identify patients between 2014 and 2017 who presented with cardiogenic shock before TAVR in comparison to a high-risk cohort that did not present with cardiogenic shock. The primary outcome of interest was 30-day mortality. Secondary outcomes included 30-day procedural complications.
Results Presentations with cardiogenic shock currently represent 4.1% of the U.S. TAVR population. A total of 2,220 patients with acute cardiogenic shock undergoing TAVR (median STS 9.8) were compared with 12,851 high-risk patients (median STS 10.2). Cardiogenic shock was associated with higher 30-day mortality (19.1% vs. 4.9%) and higher rates of complications. The absence of 30-day major complications was not associated with a marked reduction in 30-day mortality, and overall procedural success rates were high. The risk of death from acute cardiogenic shock before TAVR was strongly related to the degree of shock pre-procedure.
Conclusions TAVR appears to be a viable treatment option for patients presenting with aortic stenosis and acute cardiogenic shock. Although procedural success is high, this population remains at an elevated risk of death, which appears to be mostly driven by the degree of pre-procedural shock.
This research was supported by the STS/ACC TVT Registry. The views expressed in this paper represent those of the authors, and do not necessarily represent the official views of the STS/ACC TVT Registry or its associated professional societies identified at CVQuality.ACC.org/NCDR. Dr. Vemulapalli has received grants/contracts from Abbott Vascular, Boston Scientific, American College of Cardiology, Society of Thoracic Surgeons, National Institutes of Health, Patient Centered Outcomes Research Institute, and Food and Drug Administration (NEST); and was a consultant and on the advisory board for Boston Scientific, Zafgen, Premier, and HeartFlow. Dr. Balan has received speaker fees from Abiomed and Chiesi; and is a consultant for Osprey Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received September 4, 2019.
- Revision received February 18, 2020.
- Accepted February 25, 2020.
- 2020 American College of Cardiology Foundation
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