Efficacy and Safety of Emergent Balloon Aortic Valvuloplasty as a Rescue Therapy for Cardiogenic Shock Due to Severe Aortic Stenosis in Non-TAVI Centers

Background The prognosis of aortic stenosis (AS) with cardiogenic shock remains poor, and optimal initial treatment remains unclear. Emergent balloon aortic valvuloplasty (BAV) is a treatment option for salvage and recent studies have reported that early release of valve obstruction by emergent BAV could improve prognosis. This study aimed to assess the efficacy and safety of emergent BAV for severe AS with cardiogenic shock. Methods A total of 41 patients with severe AS in cardiogenic shock were enrolled and divided into the emergent (underwent BAV within 12h of admission, n = 10) and non-emergent (underwent BAV more than 12h after admission, n = 15) groups, after excluding 16 patients who did not undergo BAV. The primary endpoints were the 30-day mortality rate and procedural complications. The secondary endpoints were days to withdrawal from the mechanical circulatory support (MCS), days to initial rehabilitation, and clinical frailty scale (CFS) score at discharge. Results The 30-day mortality rate was not significantly different between the emergent and non-emergent groups (10% vs. 20%, p = 0.63). One patient experienced stroke after procedure in the non-emergent group. The days to withdrawal from MCS and to start rehabilitation were earlier in emergent group (2.9 ± 1.2 days vs. 7.8 ± 4.6 days; p < 0.01, 4.2 ± 1.9 days vs. 10.8 ± 6.5 days; p < 0.01). The CFS score at discharge in the emergent group was maintained compared to before admission (from 3.8 ± 1.0 to 3.9 ± 1.1; p = 0.35), whereas worsened in the non-emergent group (from 3.8 ± 0.9 to 4.6 ± 1.2; p = 0.03). Conclusions Emergent BAV for cardiogenic shock is feasible, and earlier BAV would provide immediate recovery and prevent deterioration of frailty.