Urgent transcatheter aortic valve implantation in patients with severe aortic stenosis and acute heart failure

Background Severe aortic stenosis (AS) is a frequent valvular disease in the elderly, often progressing to acute heart failure or cardiogenic shock with high mortality. Transcatheter Aortic Valve Implantation (TAVI) has improved outcomes across all surgical risk categories; however, urgent TAVI remains challenging due to greater comorbidities and higher procedural risk. Purpose This study aimed to describe and compare the clinical characteristics and in-hospital outcomes of patients with severe AS undergoing urgent versus elective TAVI. Methods A retrospective review was conducted on 63 patients with severe aortic stenosis (AS) who underwent TAVI from April 2021 to November 2024. Patients were categorized into two groups: elective TAVI (scheduled procedures, n=29) and urgent TAVI (emergency hospitalizations for acute heart failure requiring TAVI, n=34). We compared clinical, echocardiographic, and laboratory data using Student’s t-test and χ² test, considering p<0.05 as significant. Logistic regression analysis was performed to explore the association between patient characteristics and clinical presentation. Results The mean age was 73±9.2 years; 54% were women. The urgent TAVI group had lower LVEF (36% vs. 57%, p=0.002), higher EuroSCORE II (5.65 vs. 1.65, p<0.001), and longer time to intervention (13 vs. 1 day, p=0.001) compared to the elective group. The Edwards Sapien balloon-expandable valve was implanted in 57.1% of cases. Echocardiographic findings of poor prognosis were more frequent in urgent patients (right and left ventricular dilation, moderate-to-severe mitral regurgitation). Urgent patients also showed higher NT-proBNP, CRP, AST, lactate, and leukocyte levels. Procedural success was 100% in both groups. Hospital stay was longer in the urgent group (19 vs. 5 days), with 30-day mortality of 14.7%, mainly of cardiac cause versus 0% in the elective group. Odds ratios and associations are shown in the volcano plot (A) and the forest plot (B). Conclusions Patients undergoing urgent TAVI presented greater clinical and hemodynamic compromise than elective cases, yet achieved similar procedural success. Despite longer hospitalization and higher early mortality, TAVI demonstrated feasibility and safety in both urgent and elective settings.