Management of patients with acute heart failure/cardiogenic shock complicating a valvular disease

Abstract

Cardiogenic shock (CC) is the most advanced and severe stage of heart failure. Its management requires a rapid diagnosis, an etiological evaluation and the initiation of an adapted treatment as soon as possible. Even if ischemic etiology remains preponderant, the prevalence of other causes, notably valvular, is constantly increasing. In our industrialized countries, aortic stenosis is the most frequent valve disease, followed by mitral insufficiency, aortic insufficiency and mitral stenosis. While the management of these valvulopathies is well codified and has been evolving over the last few years, acute management is less clear. Inotropic treatments and mechanical circulatory support are part of the therapeutic arsenal available, but the correction of the valve disease remains the main problem. Conventional surgery is unfortunately difficult to consider because of its high moribidity and mortality. Percutaneous techniques are therefore an alternative, even if few data are available and their development according to the type of valve disease is uneven. This update provides an overview of the different valve diseases in the context of CC and summarizes the different therapeutic options available in such a critical situation.