Acute cardiac care & resuscitation
Outcomes of transcatheter aortic valve replacement in patients with cardiogenic shock
Authors' conclusion
This large observational real-world study demonstrates that the TAVR is a safe and effective treatment for aortic stenosis patients presenting with CS. Patients who survived the first 30 days after TAVR had similar mortality rates to those who were not in CS.
Study context
- Population
- Patients undergoing transcatheter aortic valve replacement (TAVR) with SAPIEN 3/SAPIEN 3 Ultra balloon-expandable valves, STS/ACC TVT Registry, June 2015–September 20225,006 (1.6%) with cardiogenic shock (CS)
- Participants
- 309,505 patients
- Exposure
- TAVR in CS vs TAVR without CS
- CSn = 5,006
- Outcome
- All-cause mortality
Methodological detailspropensity-matched analysis, landmark analysis at 30 days, multivariable Cox analysis
- Propensity-matched analysis
- Landmark analysis at 30 days
- Multivariable Cox analysis
Main finding
As reported in the abstract
In-hospital mortality
30-day mortality
1-year mortality
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| 1-year mortality, landmark analysis after 30 daysSimilar between groups | 1.07 (0.95–1.21) | |
| 0.512Hazard ratio (log scale) |
- 1-year mortality, landmark analysis after 30 days: landmark analysis at 30 days
Baseline risk and procedural results in CS patients
- Mean STS score
- 10.76 ± 10.4
- Valve successfully implanted
- 97.9%
- Technical success (VARC-3)
- 94.5%
Functional class and quality of life in CS patients alive at 1 year
- NYHA class I/II
- 89%
- ΔKCCQ score
- +50
Independent predictors of 1-year mortality (multivariable Cox)
- Older age, HR
- 1.02 (1.02-1.03) (95% CI)
- PAD, HR
- 1.25 (1.06-1.47) (95% CI)
- Prior ICD, HR
- 1.37 (1.07-1.77) (95% CI)
- Dialysis, HR
- 2.07 (1.69-2.53) (95% CI)
- Immunocompromised status, HR
- 1.33 (1.05-1.69) (95% CI)
- NYHA class III/IV, HR
- 1.50 (1.06-2.12) (95% CI)
- Lower aortic valve mean gradient, lower albumin, lower haemoglobin and lower KCCQ scores also independently associated
Original publication
Outcomes of transcatheter aortic valve replacement in patients with cardiogenic shock. Eur Heart J. Published 23 June 2023. doi:10.
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