Background: Cardiogenic shock (CS) induced by severe aortic stenosis (AS) is a life-threatening condition with high mortality. Despite advancements in emergency interventions, the optimal treatment approach remains uncertain. Aim: This study aimed to systematically review and analyse the existing evidence on outcomes of emergency transcatheter aortic valve implantation (eTAVI) and emergency balloon aortic valvuloplasty (eBAV) in CS patients. Methods: A systematic literature review and meta-analysis was performed. The primary endpoint was mortality at 30 days. Secondary endpoints were in-hospital mortality, 1-year mortality, bleeding, major vascular complications, myocardial infarction, stroke, incidence of pacemaker implantation, acute kidney injury and aortic regurgitation. Results: Seventeen studies were included, totalling 2811 patients. The analysis revealed a 30-day mortality pooled estimated rate for eTAVI of 19% (CI 0.17 - 0.20) and for eBAV 39% (CI 0.32 - 0.46). In-hospital mortality pooled estimated rates were 11% for eTAVI (CI 0.06 - 0.18) and for eBAV 40% (CI 0.28 - 0.54). One-year mortality pooled estimated rates for eTAVI were 29% (CI 0.20 - 0.40) and for eBAV 67% (CI 0.58 - 0.74). Pooled estimated rates of any bleeding were 12% for eTAVI (CI 0.06 - 0.20) and 15% for eBAV (CI 0.10 - 0.21). The rate of major vascular complications for eTAVI was 8% (CI 0.07 - 0.10) and 3% for eBAV (CI 0.0 - 0.23). Conclusions: This meta-analysis indicates that mortality in CS due to AS remains high despite emergency interventional treatment. These findings offer critical insights for clinical decision-making optimising patient care in this critically ill population.

Background: Late adverse events after percutaneous coronary intervention continue to occur beyond the first year with last‐generation drug‐eluting stents (DES). The coronary bioadaptor marks a new approach with an uncaging beginning at approximately 6 months after implantation. We conducted a pairwise meta‐analysis of bioadaptor versus DES in randomised trials with complementary single‐arm 6–12 and 6–24 landmark analyses. Methods: The systematic review and meta‐analysis was conducted according to PRISMA 2020 Guidelines. PubMed, Embase, CENTRAL and Google Scholar were searched for studies reporting clinical outcomes after bioadaptor implantation. The primary outcome was target‐lesion failure (TLF), a composite of cardiac death, target‐vessel myocardial infarction and target‐lesion revascularisation at 1 year. Secondary outcomes were TLF and individual components at landmark intervals 6–12 and 6–24 months. Single‐arm pooled event rates and pairwise comparisons were estimated using generalised linear mixed‐effects models. Results: Three randomised trials ( n = 2892; 1448 bioadaptor, 1444 DES) were included in pairwise analyses. 1‐year TLF showed no significant difference between bioadaptor and DES (OR 0.81, 95% CI 0.51–1.31, I ² = 0.0%, p = 0.3943). Likewise, individual components of TLF and device thrombosis did not differ between groups. Ten studies (1753 patients; 1900 lesions) were included in single‐arm analyses. Landmark TLF was 0.57% (95% CI 0.07–4.29; I ² = 4.6%) from 6 to 12 months and 2.01% (95% CI 0.81–4.92; I ² = 74.2%) from 6 to 24 months. Event rates for other endpoints were generally low. Conclusions: No significant differences in safety and efficacy outcomes were observed between bioadaptor and DES. Complementary single‐arm landmark analyses suggested low late event rates, but these findings should be interpreted as exploratory. Further randomised trials are warranted.

Severe mitral regurgitation (MR) is one of the most common valvular heart diseases and is frequently associated with advanced left ventricular (LV) systolic dysfunction. Transcatheter edge-to-edge repair (TEER) offers effective symptom relief but may induce abrupt hemodynamic changes leading to afterload mismatch and acute LV failure. Levosimendan may help mitigate this complication by improving contractility, yet evidence supporting its use in this setting is scarce. Therefore, the aim of this study was to systematically evaluate the evidence on the effects of Levosimendan in patients with severe MR and LV dysfunction undergoing TEER. We performed a comprehensive search of PubMed, Embase, Scopus, and Google Scholar. Primary outcomes were postprocedural LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes included procedural success, procedure duration, and in-hospital complications. Five studies comprising 315 patients (n = 141 Levosimendan, n = 174 controls) met the inclusion criteria. Pooled analysis showed no significant difference in postprocedural LVEF between Levosimendan-treated patients and controls (mean difference 0.45%, 95% CI [−1.46–2.35] p = 0.65) and no significant change from baseline. Similarly, postprocedural sPAP did not differ significantly. Procedural success was higher with Levosimendan, and procedure duration was shorter. These hypothesis-generating findings highlight the need for larger, prospective randomized trials to clarify the role of Levosimendan in this setting.