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Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States.

Publication ,  Journal Article
Masha, L; Vemulapalli, S; Manandhar, P; Balan, P; Shah, P; Kosinski, AS; Stewart, G
Published in: JACC Cardiovasc Interv
June 8, 2020

OBJECTIVES: This paper details trends and outcomes in U.S. patients undergoing transcatheter aortic valve replacement (TAVR) who present pre-procedurally with cardiogenic shock. BACKGROUND: Demographic, procedural characteristics, and clinical outcomes in U.S. patients undergoing TAVR after presenting with cardiogenic shock are unknown. METHODS: The STS/ACC TVT (Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy) registry linked with Centers for Medicare & Medicaid Services claims data was used to identify patients between 2014 and 2017 who presented with cardiogenic shock before TAVR in comparison to a high-risk cohort that did not present with cardiogenic shock. The primary outcome of interest was 30-day mortality. Secondary outcomes included 30-day procedural complications. RESULTS: Presentations with cardiogenic shock currently represent 4.1% of the U.S. TAVR population. A total of 2,220 patients with acute cardiogenic shock undergoing TAVR (median STS 9.8) were compared with 12,851 high-risk patients (median STS 10.2). Cardiogenic shock was associated with higher 30-day mortality (19.1% vs. 4.9%) and higher rates of complications. The absence of 30-day major complications was not associated with a marked reduction in 30-day mortality, and overall procedural success rates were high. The risk of death from acute cardiogenic shock before TAVR was strongly related to the degree of shock pre-procedure. CONCLUSIONS: TAVR appears to be a viable treatment option for patients presenting with aortic stenosis and acute cardiogenic shock. Although procedural success is high, this population remains at an elevated risk of death, which appears to be mostly driven by the degree of pre-procedural shock.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

June 8, 2020

Volume

13

Issue

11

Start / End Page

1314 / 1325

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Shock, Cardiogenic
  • Risk Factors
  • Risk Assessment
  • Registries
  • Postoperative Complications
  • Male
 

Citation

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Chicago
ICMJE
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Masha, L., Vemulapalli, S., Manandhar, P., Balan, P., Shah, P., Kosinski, A. S., & Stewart, G. (2020). Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States. JACC Cardiovasc Interv, 13(11), 1314–1325. https://doi.org/10.1016/j.jcin.2020.02.033
Masha, Luke, Sreekanth Vemulapalli, Pratik Manandhar, Prakash Balan, Pinak Shah, Andrzej S. Kosinski, and Garrick Stewart. “Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States.JACC Cardiovasc Interv 13, no. 11 (June 8, 2020): 1314–25. https://doi.org/10.1016/j.jcin.2020.02.033.
Masha L, Vemulapalli S, Manandhar P, Balan P, Shah P, Kosinski AS, et al. Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States. JACC Cardiovasc Interv. 2020 Jun 8;13(11):1314–25.
Masha, Luke, et al. “Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States.JACC Cardiovasc Interv, vol. 13, no. 11, June 2020, pp. 1314–25. Pubmed, doi:10.1016/j.jcin.2020.02.033.
Masha L, Vemulapalli S, Manandhar P, Balan P, Shah P, Kosinski AS, Stewart G. Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States. JACC Cardiovasc Interv. 2020 Jun 8;13(11):1314–1325.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

June 8, 2020

Volume

13

Issue

11

Start / End Page

1314 / 1325

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Shock, Cardiogenic
  • Risk Factors
  • Risk Assessment
  • Registries
  • Postoperative Complications
  • Male