Circulatory support in severe aortic stenosis

Aksoy et al acknowledge the limitations of retrospective uncontrolled data, but have nevertheless provided reassuring evidence that IABP placement in the context of aortic stenosis and cardiogenic shock is safe and results in clinically significant haemodynamic improvement, as well as reminding us that ultimately survival is dependent on the relief of mechanical obstruction. Aksoy et al are right to say that the ability to stabilise these critically ill subjects, even temporarily, is crucial, as it allows clinicians to review available data and evaluate the risks and benefits of definitive treatment. This paper therefore supports the routine use of IABP inpatients with aortic stenosis who present with cardiogenic shock, with a view to conventional aortic valve replacement surgery, TAVI or BAVonce stabilised.