{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:06:35Z","timestamp":1785409595812,"version":"3.56.0"},"reference-count":30,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background:The development of symptoms or left ventricular dysfunction in severe aortic stenosis (AS) is associated with high morbidity and mortality. While elective transcatheter aortic valve replacement (TAVR) is supported by robust randomized evidence, data on TAVR performed in non-elective settings (urgent, emergent, or salvage) remain limited and heterogeneous. In these settings, outcomes may be influenced more by baseline clinical severity than by procedural factors. This study aimed to systematically evaluate the safety and effectiveness of non-elective TAVR and to compare the associated outcomes with those of elective TAVR.Methods:This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered with PROSPERO. The PubMed, Embase, and Scopus databases were searched for studies published after 2002 evaluating urgent, emergent, or salvage TAVR in adult patients with severe AS. Eligible studies were required to include elective TAVR as a comparator. Outcomes included mortality and major procedural complications. Prespecified era-based analyses and sensitivity analyses excluding studies at critical risk of bias were performed. Risk of bias was assessed using the ROBINS-I tool.Results:A total of 17 observational studies published between 2015 and 2025 were included, comprising 215,141 patients. Compared with elective patients, those undergoing non-elective TAVR had more advanced heart failure, higher NYHA class, greater comorbidity burden, and higher surgical risk scores, whereas baseline echocardiographic severity of AS was similar. Pooled outcomes for non-elective TAVR showed in-hospital, 30-day, and 1-year mortality rates of 5.1%, 12.4%, and 26.7%, respectively. Non-elective TAVR was associated with higher mortality at all time points compared with elective procedures; meanwhile, rates of stroke, vascular complications, and permanent pacemaker implantation were similar, while major bleeding and acute kidney injury were more frequent. Era-based analyses showed a stable relative mortality risk over time.Conclusions:Although non-elective TAVR is associated with worse outcomes than elective procedures, these differences appear to be largely driven by baseline clinical severity rather than by the transcatheter intervention. In unstable patients with severe AS, non-elective TAVR remains the most effective definitive treatment option compared with balloon aortic valvuloplasty or conservative management.The PROSPERO Registration:CRD420251239620, https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251239620.<\/jats:p>","DOI":"10.31083\/rcm49738","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":0,"title":["When Time Matters in Aortic Stenosis: Can Transcatheter Aortic Valve Replacement Make a Difference in Non-Elective Cases?"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0278-2192","authenticated-orcid":true,"given":"Cecilia","family":"Villa Etchegoyen","sequence":"first","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8769-5471","authenticated-orcid":true,"given":"Laur\u00e8ve","family":"Chollet","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Bilauca","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan M","family":"Farina","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA"},{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagros","family":"Pereyra","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel G.","family":"Scalia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahshad","family":"Razaghi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatmaelzahraa E.","family":"Abdelfattah","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Awad","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman","family":"Hafez","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadi","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Alsidawi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Sweeney","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Lester","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fortuin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen A.","family":"Sell-Dottin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Arsanjani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Osnabrugge RLJ, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, et al. 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European Heart Journal. 2017; 38(suppl 1): P3295.","DOI":"10.1093\/eurheartj\/ehx504.P3295"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Amgai B, Patel N, Chakraborty S, Bandyopadhyay D, Hajra A, Koirala S, et al. 30-day readmission following urgent and elective transcatheter aortic valve replacement: A Nationwide Readmission Database analysis. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2021; 98: E1026\u2013E1032.","DOI":"10.1002\/ccd.29918"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Berkovitch A, Segev A, Finkelstein A, Kornowski R, Danenberg H, Fefer P, et al. Procedural and remote outcomes among patients undergoing urgent transcatheter aortic valve implantation. 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Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2016; 11: 1530\u20131536.","DOI":"10.4244\/EIJY15M03_03"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Ichibori Y, Li J, Patel T, Lipinski J, Ladas T, Saric P, et al. Short-Term and Long-Term Outcomes of Patients Undergoing Urgent Transcatheter Aortic Valve Replacement Under a Minimalist Strategy. The Journal of Invasive Cardiology. 2019; 31: E30\u2013E36.","DOI":"10.25270\/jic\/18.00221"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Kabahizi A, Sheikh AS, Williams T, Tanseco K, Myat A, Trivedi U, et al. Elective versus urgent in-hospital transcatheter aortic valve implantation. 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Hospital intervention volume affects outcomes of emergency transcatheter aortic valve implantations in Germany. Scientific Reports. 2022; 12: 17483.","DOI":"10.1038\/s41598-022-20336-y"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Saleh O, Saleh I, Valle N, Jafar O, Summers M. Prognostic impact of procedural urgency status in TAVR: a comparative analysis of in-hospital and 1-year outcomes from a large real-world database. Journal of the American College of Cardiology. 2025; 86(17 suppl): B497.","DOI":"10.1016\/j.jacc.2025.09.1378"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Slade JJ, Ambrosy AP, Leong TK, Sung SH, Garcia EA, Ku IA, et al. Outcomes of Adults with Severe Aortic Stenosis Undergoing Urgent or Emergent vs. Elective Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System. 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The New England Journal of Medicine. 2010; 363: 1597\u20131607.","DOI":"10.1056\/NEJMoa1008232"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Dimitriadis K, Pyrpyris N, Aznaouridis K, Bonnet G, Beneki E, Theofilis P, et al. Direct Comparison of Urgent Transcatheter Aortic Valve Implantation and Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2025; 106: 3378\u20133384.","DOI":"10.1002\/ccd.70208"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM49738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:55Z","timestamp":1785407515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM49738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":30,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)02398-7"],"URL":"https:\/\/doi.org\/10.31083\/rcm49738","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"49738"}}