What does this research mean for the field?

Urgent TAVR in low-intermediate risk patients offers comparable procedural success and adjusted 30-day mortality to elective TAVR, but is independently associated with increased acute kidney injury and 12-month mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 28, 2025JACC Advances5 citationsOpen Access

Urgent vs Elective Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

JZJennifer ZhouThe Alfred Hospital SNShane NanayakkaraThe Alfred Hospital RJRozanne JohnstonThe Alfred Hospital

Structured PICO

Does urgent TAVR compared to elective TAVR affect 30-day mortality and long-term outcomes in patients with severe aortic stenosis?

Population

1,414 consecutive patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) at 2 high-volume centers between 2017 and 2023. The cohort is described as low-intermediate risk.

Intervention

Urgent transcatheter aortic valve replacement (TAVR)

Comparator

Elective transcatheter aortic valve replacement (TAVR)

Outcome

30-day mortalityhard clinical

Urgent TAVR for severe aortic stenosis has comparable procedural success and adjusted 30-day mortality to elective TAVR, but is associated with significantly higher risks of acute kidney injury and 12-month mortality.

Abstract

BACKGROUND: Urgent transcatheter aortic valve replacement (TAVR) is increasingly performed for acutely decompensated aortic stenosis, but outcome data remain limited, particularly in contemporary lower-risk populations. OBJECTIVES: This study aimed to compare characteristics, procedural success, and outcomes among patients undergoing urgent vs elective TAVR. METHODS: Consecutive patients who underwent TAVR at 2 high-volume centers between 2017 and 2023 were included. The primary outcome was 30-day mortality. Secondary outcomes included procedural success, in-hospital complications, and postdischarge outcomes at 30 days and 12 months. RESULTS: Of 1,414 patients undergoing TAVR, 127 (9.0%) underwent urgent procedures (median Society of Thoracic Surgeons Predicted Risk of Mortality score 3.3 Q1-Q3: 2.0-5.0). Compared to elective cases, urgent TAVR patients were younger, more likely to reside in regional or socioeconomically disadvantaged areas, and exhibited more severe valve stenosis with greater cardiac remodeling. Procedural success and post-TAVR valve function were similar between groups. However, urgent TAVR was associated with higher rates of acute kidney injury (9.2% vs 3.4%, P = 0.002), 30-day mortality (2.9% vs 0.8%, P = 0.04), and 12-month mortality (14.3% vs 5.3%, P = 0.02). After multivariable adjustment, 30-day mortality differences were no longer significant, but urgent TAVR remained independently associated with increased acute kidney injury (adjusted OR: 2.43; 95% CI: 1.17-5.05; P = 0.017) and 12-month mortality (adjusted HR: 3.18; 95% CI: 1.06-9.54; P = 0.04). CONCLUSIONS: In this low-intermediate risk cohort, urgent TAVR offered comparable procedural success and adjusted 30-day mortality to elective TAVR but was associated with higher 12-month mortality. These findings support urgent TAVR as a feasible short-term intervention while highlighting the need for targeted strategies to optimize long-term outcomes in high-risk populations.

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