B50-32 Rapid Recovery of Left Ventricular Function Following Transcatheter Aortic Valve Replacement in a Patient With Critical Aortic Stenosis and Cardiogenic Shock on Peritoneal Dialysis

Abstract Introduction Critical aortic stenosis causing cardiogenic shock has very high mortality, particularly in patients with end-stage renal disease (ESRD) and multivalvular involvement. options for surgical aortic valve replacement (SAVR) are often limited by prohibitive perioperative risk. Transcatheter aortic valve replacement (TAVR) has emerged as a lifesaving alternative in select high-risk populations. We describe a patient with ESRD who presented in cardiogenic shock due to critical aortic stenosis (AS) and experienced dramatic reversal of left ventricular (LV) dysfunction following TAVR. Case A 62-year-old male with ESRD on peritoneal dialysis and hypertension presented with acute chest pain and dyspnea. Laboratory findings revealed elevated Troponin T (353ng/L) and Pro-BNP (70,000 pg/mL). He was admitted for non-ST elevation myocardial infarction; however, coronary angiography demonstrated no coronary artery disease. Transthoracic echocardiogram (TTE) revealed a left ventricular ejection fraction (LVEF) of 15-20%, sever global akinesis, eccentric left ventricular hypertrophy, and severe aortic stenosis (mean gradient 34 mmHg, valve area 0.53 cm²). Additional findings included severe aortic regurgitation and severe mitral regurgitation. Overnight, he developed altered mentation, cold extremities and lactic acidosis (14.5 mmol/L), Pulmonary artery catheter readings were consistent with cardiogenic shock. Repeat TTE redemonstrated critical aortic stenosis (peak velocity 5.3 m/s, mean gradient 71 mmHg, valve area 0.73 cm²). An urgent TAVR was performed with deployment of a 26 mm Edwards Sapien 3 pericardial prosthesis. A post-procedure TTE demonstrated LVEF improvement to 50-55%, with only mild residual LV hypokinesis. The patient showed rapid clinical recovery and was weaned off inotropes. Discussion Severe aortic stenosis imposes a fixed obstruction to left ventricular outflow, leading to excessive afterload and secondary systolic dysfunction. The rapid improvement in ejection fraction following TAVR supports the concept of afterload-induced myocardial stunning rather than irreversible cardiomyopathy. Although TAVR was traditionally avoided in unstable or shock patients, particularly those with ESRD, growing evidence supports its use as a rescue therapy in carefully selected cases. By reducing afterload, TAVR restores forward cardiac output, enhances coronary perfusion, and can reverse shock. Emerging registry data demonstrates that patients with severe AS and cardiogenic shock can achieve meaningful recovery following TAVR when performed expeditiously. This case underscores the expanding role of TAVR in managing cardiogenic shock due to severe valvular disease. The magnitude of left ventricular recovery in this case underscores the reversibility of left ventricular dysfunction once the mechanical obstruction is relieved, it highlights the importance of early recognition and intervention before irreversible myocardial remodeling occurs. This abstract is funded by: NA