Survival of Severe Aortic Stenosis Complicated with Cardiogenic Shock by Emergent Transcatheter Aortic Valve Implantation and Intra-Aortic Balloon Pump

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Objective: To learn the management of severe aortic stenosis (AS) complicated by cardiogenic shock.

Case Presentation: The case was an 89-year-old female with a past medical history of diabetes and stroke. She presented to another hospital after a syncopal episode. While waiting for further evaluation, she suddenly became unresponsive, and the monitor showed asystole. She was immediately resuscitated, and transthoracic echocardiography showed severe AS. Therefore, she was transferred to our hospital for further management including transcatheter aortic valve implantation (TAVI). During echocardiography, the patient developed hypotension and diffuse ST-segment depression. Transthoracic echocardiography revealed severe mitral regurgitation with preserved ejection fraction. Emergent coronary angiography did not show significant stenosis, and the patient was considered to be in cardiogenic shock secondary to severe AS. Emergent TAVI was performed under intra-aortic balloon support. Post TAVI course was uneventful, and at 1-year follow-up, the patient was in stable condition. Echocardiography at 1 year showed normal prosthetic valve function and mild mitral regurgitation.

Conclusion: Favorable outcome of severe AS complicated with cardiogenic shock could be achieved with emergent TAVI and mechanical circulatory support. Further study is warranted to identify risk factors for acute decompensation of AS causing cardiogenic shock.