Abstract
From January 2013 to January 2017, 686 consecutive patients were referred to our centre
for transcatheter aortic valve replacement, including 5 subjects with severe aortic
regurgitation and acute refractory cardiogenic shock. These patients were contraindicated
for surgical treatment by the heart team because of high surgical risk (median logistic
EuroSCORE: 74.6/Society of Thoracic Surgeons score: 37.9). The success rate of valve
implantation was 100% through transfemoral access with self-expandable devices. The
observed 30-day mortality rate was 20%. Hence, the transcatheter aortic valve replacement
procedure might represent a successful and life-saving intervention for treatment
of patients with severe aortic regurgitation who present with acute refractory cardiogenic
shock.
Résumé
De janvier 2013 à janvier 2017, nous avions reçu à notre centre 686 patients, dont
5 souffraient d’une régurgitation aortique grave et d’un choc cardiogénique aigu réfractaire,
pour un remplacement valvulaire aortique par cathéter. L’équipe de cardiologie avait
déconseillé le traitement chirurgical chez ces patients en raison de leur risque opératoire
élevé (EuroSCORE logistique médian : 74,6/score de la Society of Thoracic Surgeons : 37,9). L’implantation valvulaire par voie fémorale de dispositifs auto-extensibles
atteignait un taux de réussite de 100 %. Le taux de mortalité observé à 30 jours était
de 20 %. Pour cette raison, le remplacement valvulaire aortique par cathéter serait
considéré comme une intervention efficace et salvatrice dans le traitement des patients
atteints d’une régurgitation aortique grave qui souffrent d’un choc cardiogénique
aigu réfractaire.
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References
- 2017 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38: 2739-2791
- TCT-448 transcatheter aortic valve replacement for isolated severe native aortic valve regurgitation – results from the TAVR-NAVR Registry.J Am Coll Cardiol. 2017; 70: B184
- Urgent transcatheter aortic valve implantation in patients with severe aortic stenosis and acute heart failure: procedural and 30-day outcomes.Can J Cardiol. 2016; 32: 726-731
- Transapical transcatheter aortic valve replacement in patients with cardiogenic shock.Interact Cardiovasc Thorac Surg. 2012; 14: 426-430
- Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis.EuroIntervention. 2016; 11: 1530-1536
Article info
Publication history
Published online: December 05, 2017
Accepted:
November 27,
2017
Received:
October 15,
2017
Footnotes
See page 342.e7 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
