Objective The optimal treatment of patients with acute and severe decompensation of aortic stenosis is unclear due to recent advances in transcatheter interventions and supportive therapies. Our aim was to assess the early outcome of emergency transcatheter aortic valve implantation (eTAVI) versus emergency balloon aortic valvuloplasty (eBAV) followed by TAVI under elective circumstances.
Methods Emergency conditions were defined as: cardiogenic shock with requirement of catecholamine therapy, severe acute dyspnoea (NYHA IV), cardiac resuscitation or mechanic respiratory support. The data were collected according to the Valve Academic Research Consortium 2 (VARC-2) criteria.
Results In five German centres, 23 patients (logistic Euroscore 37.7%±18.1) underwent eTAVI and 118 patients underwent eBAV (logistic Euroscore 35.3%±20.8). In the eTAVI group, immediate procedural mortality was 8.7%, compared with 20.3% for the eBAV group (p=0.19). After 30 days, cardiovascular mortality for the eTAVI group was 23.8% and for the eBAV group 33.0% (p=0.40). Analyses adjusting for potential confounders did not provide evidence of a difference between groups. Of note, the elective TAVI performed after eBAV (n=32, logistic Euroscore 25.9%±13.9) displayed an immediate procedural mortality of 9.4% and a cardiovascular mortality after 30 days of 15.6%. Major vascular complications were significantly more likely to occur after eTAVI (p=0.01) as well as stroke (p=0.01).
Conclusion In this multicentre cohort, immediate procedural and 30-day mortality of eTAVI and eBAV were high, and mortality of secondary TAVI subsequent to eBAV was higher than expected. Randomised study data are required to define the role of emergency TAVI in tertiary care centres with current device generations.
- emergency TAVI
- severe aortic stenosis
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Contributors DB collected, harmonised and analysed the data and wrote and submitted the manuscript. CK collected, analysed and interpreted the data and reviewed the manuscript. LS performed the statistical analysis. FP helped to collect the data. SB, MG, JM, SM, NF, RL, GS, DF and CK performed the balloon aortic valvuloplasty and transcatheter aortic valve implantation. K-LL reviewed and corrected the manuscript. CK planned and supervised the study, interpreted the results and wrote and revised the manuscript.
Competing interests None declared.
Ethics approval Ethics Committee, Klinikum rechts der Isar, Munich, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All the available data have been inserted in the Paper. There are not any other data available concerning this publication.