Emergency interventions for cardiogenic shock due to decompensated aortic stenosis: a systematic review and meta-analysis

Open Heart. 2025 Jan 19;12(1):e003110. doi: 10.1136/openhrt-2024-003110.

Abstract

Background: Cardiogenic shock (CS) induced by severe aortic stenosis (AS) is a life-threatening condition with high mortality. Despite advancements in emergency interventions, the optimal treatment approach remains uncertain.

Aim: This study aimed to systematically review and analyse the existing evidence on outcomes of emergency transcatheter aortic valve implantation (eTAVI) and emergency balloon aortic valvuloplasty (eBAV) in CS patients.

Methods: A systematic literature review and meta-analysis was performed. The primary endpoint was mortality at 30 days. Secondary endpoints were in-hospital mortality, 1-year mortality, bleeding, major vascular complications, myocardial infarction, stroke, incidence of pacemaker implantation, acute kidney injury and aortic regurgitation.

Results: Seventeen studies were included, totalling 2811 patients. The analysis revealed a 30-day mortality pooled estimated rate for eTAVI of 19% (CI 0.17 - 0.20) and for eBAV 39% (CI 0.32 - 0.46). In-hospital mortality pooled estimated rates were 11% for eTAVI (CI 0.06 - 0.18) and for eBAV 40% (CI 0.28 - 0.54). One-year mortality pooled estimated rates for eTAVI were 29% (CI 0.20 - 0.40) and for eBAV 67% (CI 0.58 - 0.74). Pooled estimated rates of any bleeding were 12% for eTAVI (CI 0.06 - 0.20) and 15% for eBAV (CI 0.10 - 0.21). The rate of major vascular complications for eTAVI was 8% (CI 0.07 - 0.10) and 3% for eBAV (CI 0.0 - 0.23).

Conclusions: This meta-analysis indicates that mortality in CS due to AS remains high despite emergency interventional treatment. These findings offer critical insights for clinical decision-making optimising patient care in this critically ill population.

Keywords: Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Meta-Analysis; Systematic Reviews as Topic; Transcatheter Aortic Valve Replacement.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Aortic Valve Stenosis* / complications
  • Aortic Valve Stenosis* / diagnosis
  • Aortic Valve Stenosis* / mortality
  • Aortic Valve Stenosis* / surgery
  • Balloon Valvuloplasty / adverse effects
  • Balloon Valvuloplasty / methods
  • Emergencies
  • Hospital Mortality / trends
  • Humans
  • Risk Assessment
  • Risk Factors
  • Shock, Cardiogenic* / epidemiology
  • Shock, Cardiogenic* / etiology
  • Shock, Cardiogenic* / mortality
  • Shock, Cardiogenic* / therapy
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / methods
  • Treatment Outcome