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Original research article
Emergency treatment of decompensated aortic stenosis
  1. Dario Bongiovanni1,2,
  2. Constantin Kühl3,4,
  3. Sabine Bleiziffer5,
  4. Lynne Stecher6,
  5. Felix Poch1,
  6. Martin Greif7,
  7. Julinda Mehilli7,
  8. Steffen Massberg7,
  9. Norbert Frey3,4,
  10. Rüdiger Lange5,
  11. Karl-Ludwig Laugwitz1,2,
  12. Gerhard Schymik8,
  13. Derk Frank3,4,
  14. Christian Kupatt1,2
  1. 1 I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  2. 2 DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
  3. 3 Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
  4. 4 DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
  5. 5 Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
  6. 6 Institut für Medizinische Statistik und Epidemiologie, Technical University of Munich, Munich, Germany
  7. 7 Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
  8. 8 Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
  1. Correspondence to Professor Christian Kupatt, I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; christian.kupatt{at}tum.de

Abstract

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
  • BAV
  • severe aortic stenosis

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Footnotes

  • 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.

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