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Emergency interventions for the treatment of decompensated aortic stenosis
  1. Philip D Adamson1,
  2. Nicholas Cruden1,2
  1. 1Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Nicholas Cruden, Department of Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK; nick.cruden{at}ed.ac.uk

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Transcatheter aortic valve implantation (TAVI) is endorsed in both the European and North American guidelines as the treatment of choice for symptomatic severe aortic stenosis in patients considered unsuitable for surgical aortic valve replacement.1 2 Neither of these documents places an upper limit of risk precluding TAVI, although patients should have an expected post-TAVI survival of at least 1 year. In patients with acutely decompensated severe aortic stenosis where the longer-term prognosis is poor or unclear, balloon aortic valvuloplasty (BAV) may be considered either as a palliative procedure or as a potential bridge to definitive therapy. The terms used to define this subset of patients are necessarily vague, as they attempt to encompass a diverse population and avoid being overly prescriptive. A number of case series and registry studies have been published describing clinical outcomes in very high-risk or acutely decompensated patients undergoing BAV as a bridge to valve replacement,3 TAVI in cardiogenic shock4 5 and emergency surgical aortic valve replacement.6 While informative, these data are limited by the bias inherent to non-randomised, observational studies and lack of an appropriate comparator. Thus, the optimal strategy for the management of severe aortic stenosis in patients with cardiogenic shock …

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