Emergency transcatheter aortic valve implantation for acute heart failure due to severe aortic stenosis in critically ill patients with or without cardiogenic shock
| العنوان: | Emergency transcatheter aortic valve implantation for acute heart failure due to severe aortic stenosis in critically ill patients with or without cardiogenic shock |
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| المؤلفون: | Julius Steffen, Angelika Stocker, Clemens Scherer, Magda Haum, Julius Fischer, Philipp M Doldi, Hans Theiss, Daniel Braun, Konstantinos Rizas, Sven Peterß, Jörg Hausleiter, Steffen Massberg, Martin Orban, Simon Deseive |
| المصدر: | European Heart Journal. Acute Cardiovascular Care. 11:877-886 |
| بيانات النشر: | Oxford University Press (OUP), 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | General Medicine, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine |
| الوصف: | Aims Severe aortic stenosis can cause acute heart failure and cardiogenic shock (CS). Transcatheter aortic valve implantation (TAVI) is the standard therapy for aortic stenosis in inoperable patients. However, its role in this setting is poorly evaluated. The study purpose was to explore clinical characteristics of these patients and to assess predictors of mortality. Methods and results All 2930 patients undergoing transfemoral TAVI at our centre between 2013 and 2019 were screened for critically ill patients, receiving intensive care therapy and emergency TAVI. Selected patients were subdivided into two groups, according to the presence or absence of CS. Remaining patients undergoing elective TAVI served as a comparison. Primary outcome was 90-day mortality. Out of 179 critically ill patients, 47 fulfilled criteria of CS (shock group) and 132 did not despite a severe decompensation (no shock group). Shock patients were more often male and had higher Society of Thoracic Surgeons scores [15.6, interquartile range (8.0–32.1) vs. 5.5 (3.9–8.5), P < 0.01] compared with severely decompensated patients. Ninety-day mortality was: shock group, 42.6%, vs. no shock group, 15.9%, vs. elective group, 5.3% (P < 0.01). A landmark analysis from day 90 showed similar mortality (P = 0.29). Compared with elective patients, 30-day composite endpoint device failure was higher in critically ill groups [shock group, odds ratio, 2.86 (1.43–5.36), no shock group, odds ratio, 1.74 (1.09–2.69)]. Multivariable regression revealed mechanical ventilation, haemofiltration, elevated C-reactive protein or bilirubin, and hypotension before TAVI as 90-day mortality predictors. Conclusion Ninety-day mortality after TAVI in critically ill patients is increased but survivors have similar outcomes as elective patients. |
| تدمد: | 2048-8734 2048-8726 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::621913fcc03dac125fd7a530a0924b49Test https://doi.org/10.1093/ehjacc/zuac131Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi...........621913fcc03dac125fd7a530a0924b49 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20488734 20488726 |
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