Outcomes of following transcatheter and surgical interventions in patients with acute valvular dysfunction with cardiogenic shockCentral MessagePerspective
Yu Hohri, MD, PhD,
Erfan Faridmoayer, MD,
Yanling Zhao, MS, MPH,
Paul Kurlansky, MD,
Krushang Patel, MD,
Morgan Moroi, MD,
Christine Yang, BS,
Giovanni Ferrari, PhD,
Isaac George, MD,
Hiroo Takayama, MD, PhD,
Koji Takeda, MD, PhD
Affiliations
Yu Hohri, MD, PhD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Erfan Faridmoayer, MD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Yanling Zhao, MS, MPH
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY; Center for Innovation and Outcomes Research, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Paul Kurlansky, MD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY; Center for Innovation and Outcomes Research, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Krushang Patel, MD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Morgan Moroi, MD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Christine Yang, BS
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Giovanni Ferrari, PhD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Isaac George, MD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Hiroo Takayama, MD, PhD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
Koji Takeda, MD, PhD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY; Address for reprints: Koji Takeda, MD, PhD, Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, 707 Fort Washington Ave, New York, NY 10032.
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.
