EMERGENCY AORTIC-VALVE REPLACEMENT FOR CRITICAL AORTIC-STENOSIS - A LIFESAVING TREATMENT FOR PATIENTS WITH CARDIOGENIC-SHOCK AND MULTIPLE ORGAN FAILURE

Objective: To demonstrate that emergency aortic valve replacement can be successfully performed in patients with critical aortic stenosis an d reduced left ventricular function even in cardiogenic shock with ass ociated severe multiple organ failure. Design: Retrospective, consecut ive case series. Setting: Multidisciplinary intensive care unit of a t ertiary care university hospital. Patients: Five patients admitted to the intensive care unit with critical aortic stenosis (aortic valve ar ea 0.56 +/- 0.13 cm(2)) and greatly reduced left ventricular ejection fraction (20 +/- 3 %) in prolonged cardiogenic shock and associated mu ltiple organ failure (Multiple organ failure score 6.8 +/- 0.5; Acute Physiology, Age, and Chronic Health Evaluation III score 91 +/- 27). I ntervention: Emergency aortic valve replacement. Results: All patients survived with full recovery of organ function. At follow-up (18 +/- 1 0 months) all patients were in New York Heart Association functional c lass I or II with improvement of left ventricular ejection fraction to 48 +/- 25 %. Conclusions: This excellent outcome suggests that emerge ncy aortic valve replacement should be strongly considered in patients with critical aortic stenosis even in cardiogenic shock and multiple organ failure.