JACC Case Rep. 2026 Jul 14:109110. doi: 10.1016/j.jaccas.2026.109110. Online ahead of print.
ABSTRACT
BACKGROUND: Treatment of severe aortic stenosis in cardiogenic shock remains challenging, particularly in younger patients with bicuspid valve stenosis (BVS).
CASE SUMMARY: A 51-year-old woman with severe high-gradient BVS presented in cardiogenic shock with multiorgan dysfunction. Given hemodynamic instability, the heart team proceeded with urgent transcatheter aortic valve replacement. A 26-mm balloon-expandable Edwards SAPIEN 3 Ultra RESILIA valve was successfully implanted, resulting in rapid hemodynamic stabilization.
DISCUSSION: This case highlights the importance of urgent heart team decision-making in unstable patients with severe BVS. Lifetime management requires individualized device selection considering annular dimensions, calcification pattern, coronary access, and future redo-procedure strategies.
TAKE-HOME MESSAGES: In the presence of refractory cardiogenic shock, transcatheter aortic valve replacement may be the preferred treatment strategy and should be considered as part of an individualized lifetime management strategy.
PMID:42446455 | DOI:10.1016/j.jaccas.2026.109110