Conversion to Cardiac Surgery During Elective and Urgent Transcatheter Aortic Valve Implantation: A Systematic Review and Meta‐Analysis

Transcatheter aortic valve implantation (TAVI) has become an established treatment for severe aortic stenosis. However, the need for unplanned conversion to cardiac surgery (CS) during TAVI remains an infrequent but critical event. It is unclear whether this risk is higher in patients undergoing urgent procedures. We conducted a systematic review and meta-analysis to compare the incidence of unplanned conversion to CS between patients undergoing urgent versus elective TAVI. A systematic search of PubMed, SCOPUS, and Cochrane databases was performed to identify eligible studies. The primary outcome was the rate of unplanned conversion to CS. Secondary outcomes included mortality, device success, vascular complications, device embolization, acute kidney injury (AKI), stroke, permanent pacemaker implantation (PPI), moderate-or-severe paravalvular regurgitation (PVL), need for second valve implantation, bleeding, and duration of hospitalization. Seven studies comprising 71,909 patients were analyzed; 5108 underwent urgent TAVI and 66,801 underwent elective TAVI. No significant difference in conversion to CS was observed between the groups (RR: 0.89; 95% CI: 0.65-1.22). Device success rates were similar (RR: 0.99; 95% CI: 0.97-1.00). Urgent TAVI was associated with prolonged hospitalization (mean difference: 7.75 days; 95% CI: 4.06-11.45) and increased AKI risk (RR: 2.20; 95% CI: 1.53-3.16). Vascular complications, device embolization, stroke, PPI, PVL, second valve implantation, and major bleeding rates were comparable between the groups. Urgent TAVI is not associated with an increased risk of unplanned conversion to surgery. The observed higher AKI rates and longer hospital stay suggest that patient-related factors beyond procedural urgency may contribute to adverse outcomes.