Emergency TAVR supported by VA-ECMO successfully stabilized hemodynamics and led to clinical recovery in a 91-year-old woman with cardiogenic shock and Takotsubo cardiomyopathy.
Case Report (n=1)
Can ECMO-supported emergency TAVR successfully treat cardiogenic shock in an elderly patient with severe aortic stenosis and Takotsubo cardiomyopathy?
ECMO-supported emergency TAVR may serve as a viable life-saving intervention for high-risk elderly patients presenting with severe aortic stenosis complicated by cardiogenic shock and Takotsubo cardiomyopathy.
Abstract Background Differentiating Takotsubo cardiomyopathy (TCM) from myocardial infarction (MI) remains challenging, especially in elderly patients with structural heart disease. When complicated by severe aortic stenosis (AS), cardiogenic shock can rapidly develop, posing both diagnostic and therapeutic dilemmas. Case summary A 91-year-old woman presented with progressive dyspnea and was admitted for acute decompensated heart failure. Transthoracic echocardiography revealed severe AS and a reduced left ventricular ejection fraction (LVEF) of 30% with apical wall thinning, suggestive of an old MI. Despite optimal medical therapy, she developed recurrent syncope and was referred for transcatheter aortic valve replacement (TAVR). Before the scheduled procedure, the patient developed cardiogenic shock and pulseless electrical activity. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated, and emergency TAVR was performed. The patient’s hemodynamics stabilized, with subsequent clinical recovery. Coronary angiography revealed no obstructive coronary disease and left ventriculography demonstrated apical ballooning consistent with TCM. The patient was weaned from ECMO, with a subsequent improvement in LVEF. She was discharged to a rehabilitation facility. Discussion The present case highlights the diagnostic challenge of distinguishing TCM from ischemic heart disease in elderly patients with severe AS and underscores the importance of prompt, multidisciplinary decision-making in managing cardiogenic shock. Furthermore, ECMO-supported TAVR may represent a viable life-saving option in selected high-risk patients.
Bando et al. (Wed,) conducted a case report in Takotsubo cardiomyopathy with cardiogenic shock and severe aortic stenosis (n=1). VA-ECMO supported emergency TAVR was evaluated. Emergency TAVR supported by VA-ECMO successfully stabilized hemodynamics and led to clinical recovery in a 91-year-old woman with cardiogenic shock and Takotsubo cardiomyopathy.