Mortality after urgent versus elective transcatheter aortic valve replacement: a systematic review and meta-analysis using reconstructed individual patient data from Kaplan-Meier curves.

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.