Key result
Urgent TAVR linked to ~83% higher mortality compared with elective TAVR.
Why the study?
Urgent TAVR performed during unplanned hospitalizations is linked to worse outcomes compared with elective TAVR, but temporal trends in mortality remain poorly understood.
Does urgent TAVR increase mortality compared to elective TAVR in patients with severe aortic stenosis?
Meta-Analysis (n=77,108)
Yes
Does urgent TAVR increase mortality compared to elective TAVR in patients with severe aortic stenosis?
Urgent TAVR carries a nearly two-fold higher early mortality risk than elective procedures, emphasizing the critical importance of timely elective intervention before acute decompensation.
Answers are grounded in this paper and cite their sources.
Urgent TAVR warrants heightened early vigilance in acute presentations; leaves open whether accelerated elective pathways can narrow the observed survival gap.
BACKGROUND: Urgent transcatheter aortic valve replacement (TAVR), performed during unplanned hospitalizations, is linked to worse outcomes compared with elective TAVR. However, temporal trends in mortality remains poorly understood. This study aimed to compare survival after urgent versus elective TAVR using a reconstructed individual patient data (IPD) meta-analysis. METHODS: PubMed, Embase, and Scopus were searched through August 2025. Studies reporting Kaplan-Meier (KM) survival curves for urgent versus elective TAVR were included. Survival data were digitally extracted from published KM curves, and IPD were reconstructed algorithmically using a two-stage approach. Kaplan-Meier curves and Cox frailty models estimated survival and hazard ratios (HRs). Landmark analysis at one-year post-procedure and restricted mean survival time (RMST) were also employed to compare survival. RESULTS: Eleven studies including 77,108 patients were identified. Kaplan-Meier curves were available for 76,108 patients (urgent: 5,683; elective: 71,425) and used for reconstructed IPD analysis. Urgent TAVR was associated with higher early mortality (HR 1.83, 95% CI: 1.73-1.93; p < 0.001), with convergence beyond one year (HR 1.01, 95% CI: 0.84-1.22; p = 0.83). RMST analysis demonstrated a 6.5-month overall survival advantage in favor of elective TAVR (p = 0.001). CONCLUSIONS: Urgent TAVR is associated with significantly increased early mortality compared with elective TAVR. These findings highlight the prognostic implications of procedural timing and support early referral for elective intervention in patients with severe AS.
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Babaei et al. (2025) conducted a meta-analysis in Severe aortic stenosis (n=77,108). Urgent transcatheter aortic valve replacement vs. Elective transcatheter aortic valve replacement was evaluated on Overall survival (mortality) (HR 1.83, 95% CI 1.73-1.93, p=< 0.001). Urgent transcatheter aortic valve replacement was associated with an 83% increased hazard of mortality compared with elective TAVR.
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