Efficacy and safety of emergent balloon aortic valvuloplasty as a rescue therapy for cardiogenic shock due to severe aortic stenosis in non-TAVI centers.

BACKGROUND: The prognosis of aortic stenosis (AS) with cardiogenic shock remains poor, and optimal initial treatment remains unclear. Emergent balloon aortic valvuloplasty (BAV) is a treatment option for salvage and recent studies have reported that early release of valve obstruction by emergent BAV could improve prognosis. This study aimed to assess the efficacy and safety of emergent BAV for severe AS with cardiogenic shock. METHODS: Among 8,230 patients hospitalized for heart failure, 7924 patients with heart failure unrelated to severe AS were excluded. Among the remaining 306 patients, 256 patients who developed cardiogenic shock due to other causes except severe AS were further excluded. Finally, a total of 41 patients with severe AS in cardiogenic shock were enrolled and divided into the emergent (underwent BAV within 6 h of admission, n = 9) and non-emergent (underwent BAV more than 6 h after admission, n = 16) groups, after excluding 16 patients who did not undergo BAV. The primary endpoints were the 30-day mortality rate and procedural complications. The secondary endpoints were days to withdrawal from the mechanical support device, days to initial rehabilitation, and clinical frailty scale (CFS) score at discharge. RESULTS: In the emergent group, the time from admission to BAV was 3.0 ± 1.4 h, whereas BAV was performed 4.5 days (median) after admission in the non-emergent group. The 30-day mortality rate was not significantly different between the emergent and non-emergent groups (0% vs. 25%, p = 0.260); furthermore, there was no statistically significant difference regarding the incidence of procedural complications (0% in the emergent vs. 12.5% in the non-emergent group, p = 0.520). The days to withdrawal from mechanical support device and to start rehabilitation were earlier in emergent group (2.9 ± 1.2 days vs. 7.8 ± 4.6 days; p = 0.008, 4.2 ± 1.9 days vs. 10.8 ± 6.5 days; p = 0.004). The CFS score at discharge in the emergent group was maintained compared to before admission (from 3.8 ± 1.0 to 3.9 ± 1.1; p = 0.347), whereas worsened in the non-emergent group (from 3.8 ± 0.9 to 4.6 ± 1.2; p = 0.032). CONCLUSIONS: Emergent BAV for cardiogenic shock is feasible, and earlier BAV may support faster recovery and help prevent deterioration of frailty.