Systematic Review and Meta-Analysis of Interventional Emergency Treatment of Decompensated Severe Aortic Stenosis

Aims. Patients in cardiogenic shock (CS) due to decompensated aortic stenosis (AS) evidence poor prognosis. Both emergency transcatheter aortic valve replacement (eTAVR) and emergency balloon aortic valvuloplasty (eBAV) have been reported in CS patients. We aimed to summarize and compare available studies on eBAV and eTAVR in patients suffering from CS due to decompensated AS with regard to safety and efficacy. Methods and Results. Study-level data were analyzed. Heterogeneity was assessed using the I-2 statistic. Pooled proportions, ie, event rates, were calculated and obtained using a random-effects model (DerSimonian and Laird). Eight studies were found suitable for the final analysis, including 311 patients. Primary endpoint was mortality at 30 days. For eBAV (n = 238), 30-day mortality rate was 46.2% (95% confidence interval [CI], 30.3%-62.5%; I-2 =74%), major bleeding rate was 10% (95% CI, 5.4%-15.7%; I-2=13%), and stroke rate was 0.7% (95% CI, 0.0%-2.7%; I-2 =0%). Aortic regurgitation (AR) >= II all was present in 8.6% [95% CI, 0.4%-23.5%; I-2 =86%). For eTAVR (n = 73), 30-day mortality rate was 22.6% (95% CI, 12.0%-35.2%; I-2 =26%), major bleeding rate was 5.8% (95% CI. 0.5%-14.7%; I-2-=0%), and stroke rate was 5.8% [95% CI, 0.5%-14.7%; I-2 =0%). AR all was present in 4% (95% CI. 0.0%-12.1%; I-2 =0%). Conclusion. Mortality in CS patients due to decompensated severe AS is high, regardless of interventional treatment strategy. Both eBAV and eTAVR seem feasible. As eTAVR is associated with better initial improvements in hemodynamics and simultaneously avoids sequential interventions, it might be favorable to eBAV in select patients. If eTAVR is not available, eBAV might serve as a "bridge" to elective TAVR.