Management of acute decompensated valvular heart disease

Enzo Lüsebrink^#¹, Hugo Lanz^#¹, Antonia Kellnar¹, Nicole Karam², Samir Kapadia³, Raj Makkar⁴, William T Abraham⁵, Azeem Latib⁶, Martin Leon⁷, Anna Sannino^{8

9}, Mony Shuvy¹⁰, Mayra Guerrero¹¹, Neil Fam¹², Javed Butler¹³, Marianna Adamo¹⁴, Volker Rudolph¹⁵, Gilbert H L Tang¹⁶, Thomas J Stocker¹, Karl-Philipp Rommel¹⁷, Philipp Lurz¹⁸, Holger Thiele¹⁷, Steffen Massberg¹, Fabien Praz¹⁹, Bernard Prendergast²⁰, Jörg Hausleiter¹

Affiliations

¹ Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
² Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center, INSERM U970, Paris, France.
³ Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA.
⁴ Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁷ Department of Medicine, Columbia University Medical Center, New York, NY, USA.
⁸ Deutsches Herzzentrum des Charitè, Berlin, Germany.
⁹ Federico II University, Naples, Italy.
¹⁰ Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹¹ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
¹² St. Michael's Hospital Unity Health, Toronto, ON, Canada.
¹³ Baylor Scott and White Research Institute, Dallas, TX and University of Mississippi, Jackson, MS, USA.
¹⁴ Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
¹⁵ Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Universitätsklinik (Ruhr-Universität Bochum), Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany.
¹⁶ Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, USA.
¹⁷ Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
¹⁸ Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
¹⁹ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
²⁰ Heart Vascular and Thoracic Institute, Cleveland Clinic London, London, UK; Department of Cardiology, St Thomas' Hospital, London, UK.

^# Contributed equally.

PMID: 39663714
DOI: 10.1002/ejhf.3549

Review

Management of acute decompensated valvular heart disease

Enzo Lüsebrink et al. Eur J Heart Fail. 2025 Apr.

. 2025 Apr;27(4):630-649.

doi: 10.1002/ejhf.3549. Epub 2024 Dec 11.

Authors

Affiliations

¹ Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
² Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center, INSERM U970, Paris, France.
³ Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA.
⁴ Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁷ Department of Medicine, Columbia University Medical Center, New York, NY, USA.
⁸ Deutsches Herzzentrum des Charitè, Berlin, Germany.
⁹ Federico II University, Naples, Italy.
¹⁰ Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹¹ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
¹² St. Michael's Hospital Unity Health, Toronto, ON, Canada.
¹³ Baylor Scott and White Research Institute, Dallas, TX and University of Mississippi, Jackson, MS, USA.
¹⁴ Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
¹⁵ Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Universitätsklinik (Ruhr-Universität Bochum), Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany.
¹⁶ Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, USA.
¹⁷ Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
¹⁸ Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
¹⁹ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
²⁰ Heart Vascular and Thoracic Institute, Cleveland Clinic London, London, UK; Department of Cardiology, St Thomas' Hospital, London, UK.

^# Contributed equally.

PMID: 39663714
DOI: 10.1002/ejhf.3549

Abstract

Worldwide, valvular heart disease (VHD) is a common cause of hospitalization for acute heart failure. In acute heart failure caused by VHD, symptoms result from rapid haemodynamic changes and subsequent decline in cardiac function, and if left untreated, leads to acute decompensation and cardiogenic shock. Current evidence remains scarce and recommendations regarding the management of acute heart failure caused by VHD are lacking in most recent international guidelines. Herein, we review the management of acute heart failure caused by VHD with a focus on transcatheter therapies and describe currently available evidence based on a systematic literature search on the following valve pathologies: (i) aortic stenosis, (ii) aortic regurgitation, (iii) mitral regurgitation, and (iv) mitral stenosis. Articles reporting outcomes following urgent or emergent valve intervention in the setting of cardiogenic shock or acute heart failure were considered. After screening a total of 2234 articles, 76 published between 1994 and 2023 were included in subsequent analysis. Based on available evidence, proposed treatment algorithms to guide optimal management of acute heart failure caused by VHD were created. As the number of patients presenting with acute heart failure caused by VHD continues to rise and outcomes following transcatheter valve interventions continue to improve, it is inevitable that minimally invasive options will play an increasingly important role in the acute setting, especially given these patients are at an increased operative risk. This review aims to present an organized approach to the complex management and interventional treatment of patients with acute heart failure caused by VHD.

Keywords: Acute decompensated heart failure; Valvular heart disease.

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References

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1. Kolte D, Khera S, Vemulapalli S, Dai D, Heo S, Goldsweig AM, et al. Outcomes following urgent/emergent transcatheter aortic valve replacement: Insights from the STS/ACC TVT Registry. JACC Cardiovasc Interv 2018;11:1175–1185. https://doi.org/10.1016/j.jcin.2018.03.002

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Management of acute decompensated valvular heart disease

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Management of acute decompensated valvular heart disease

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