Acute valvular intervention in patients suffering from cardiogenic shock in a tertiary care intensive coronary care unit

Introduction: Cardiogenic shock (CS) is a high-acuity, complex, and hemodynamically critical state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. For many years patient morbidity and mortality remain high, and there are only few evidence-based therapeutic interventions known to improve survival. We sought to evaluate acute valve intervention using trans-catheter aortic valve intervention (TAVI) and mitral clip (MC) procedures in patients presenting with CS in a tertiary intensive coronary care unit (ICCU).

Method: We analyzed patients hospitalized in a tertiary intensive coronary care unit (ICCU) at the Shaare Zedek Medical Center between January 2020- March 2021 suffering from CS from any cause. We compared 30-day mortality in patients requiring acute valve intervention vs. patients who did not required valve intervention. The society of cardiovascular angiography and interventions (SCAI) criteria were used to evaluate the severity of the CS.

Results: One hundred and three patients were hospitalized with shock from any cause. Of them 71 (69%) patients suffered from CS. Sixty-five patients (91%) did not undergo acute valvular Intervention, while 6 (9%) patients underwent acute valvular Intervention. The non-valvular intervention group mean age was 70 years old with 20% women and a 44% 30-day mortality rate. The valvular intervention group were older with mean age 77 years old (p=0.09); with 16% women (p=0.6) with a 30-day mortality rate of 0% (p=0.07). The SCAI shock classification for the vavular patients was 1- class C; 2- class D and 3- class E.

Conclusions: Although patients with CS requiring acute valvular intervention were older and had very high SCAI shock classifications, the use of TAVI and MC was associated with a greater 30-day survival. Further studies are warranted to optimize patients selection and procedure timing for those patients.