Urgent, Emergency, and Salvage Transcatheter Aortic Valve Implantation for Acute Decompensated Severe Aortic Stenosis: A Prospective Cohort Study

BACKGROUND: Acute decompensated severe aortic stenosis may preclude waiting for elective treatment, and evidence for non-elective transcatheter aortic valve implantation (TAVI) is limited. We assessed 12-month mortality, 30-day safety, and recovery after urgent, emergency, or salvage TAVI. METHODS: We prospectively enrolled patients undergoing urgent, emergency, or salvage TAVI at one centre in 2022-2025. The primary endpoint was 12-month all-cause mortality; secondary endpoints included device success, 30-day safety, and functional and echocardiographic recovery. RESULTS: Among 53 patients, 36 underwent urgent, 14 emergency, and 3 salvage TAVI. Device success was 52/53 (98.1%). Thirty-day mortality was 1/36, 0/14, and 0/3; 12-month mortality was 2/36, 1/14, and 0/3 (3/53). Kaplan-Meier 12-month survival was 94.3% (95% confidence interval 83.5-98.1%). New atrioventricular block was detected in 2/53 on postoperative day 2; by 30 days, haemofiltration or renal replacement therapy occurred in 1/53 and permanent pacemaker implantation in 0/53. At 12 months, cardiovascular mortality was 2/53, heart-failure readmission 4/53, stroke 1/53, a separate Valve Academic Research Consortium-3 type 2 bleeding event 1/53, and permanent pacemaker implantation 0/53. Paired analyses showed improved New York Heart Association class, Kansas City Cardiomyopathy Questionnaire-12, left ventricular ejection fraction, and transvalvular gradients at 30 days and 12 months (all P<0.001). CONCLUSIONS: Selected patients had high device success and low early event rates after non-elective TAVI; paired data showed sustained functional and haemodynamic improvement. These findings support timely Heart Team assessment and consideration of non-elective TAVI, when appropriate, at experienced centres; comparative benefit over alternative strategies warrants prospective study.