Outcomes of following transcatheter and surgical interventions in patients with acute valvular dysfunction with cardiogenic shock

Abstract

Objectives

Although surgery remains the gold standard treatment for acute valvular dysfunction complicated by cardiogenic shock, transcatheter management has emerged as an alternative. We examined our contemporary experience with patients requiring surgical or transcatheter interventions in conjunction with mechanical circulatory support for acute valvular dysfunction complicated by cardiogenic shock.

Methods

We retrospectively reviewed patients admitted with cardiogenic shock due to acute valvular dysfunction who underwent valve interventions at our center between 2016 and 2022. The primary end point was in-hospital mortality. Secondary end points included midterm mortality and major adverse cardiac events, including cardiac death, stroke, cardiac-related events, readmission for heart failure, and reintervention.

Results

Among 67 patients (median 75 years, interquartile range, 65-84), common valve pathologies included aortic stenosis (30 patients), mitral regurgitation (24 patients), and tricuspid regurgitation (17 patients). Preoperative mechanical circulatory support was required in 38 patients. Nineteen patients underwent open surgery, and 48 patients received transcatheter interventions, including transcatheter aortic valve replacement and edge-to-edge mitral repair. Mechanical circulatory support was required in 34 patients postoperatively. Overall in-hospital mortality was 26.9% (surgery 26.3% vs transcatheter 27.1%, P = 1.000). Median follow-up was 25.1 months (interquartile range, 20.6-33.9 months). The 2-year survival was 54.0% (95% CI, 42.2-69.0), and the cumulative incidence of major adverse cardiac events was 51.5% (95% CI, 33.8-64.4). Residual moderate or severe tricuspid regurgitation (hazard ratio, 2.266, 95% CI, 1.052-4.940, P = .037) and postoperative mechanical circulatory support (hazard ratio, 2.611, 95% CI, 1.194-5.965, P = .016) were associated with 2-year mortality.

Conclusions

Early and midterm mortality and morbidity rates remained high despite contemporary multimodal treatment approaches for acute valvular dysfunction with cardiogenic shock.