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

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ID: 337499
2026
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Abstract
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.
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Authors Menglin Zhao, Jiahao Wang, Luyao Gao, Tianshu Wu, Zerui Wang, Shuang Luo, Yong Li, Rugang Liu, 唐振宇, Meng Feng, Mingqiang Hua, Jiaquan Yuan, Yiwen Zhang, Yuan Bian, Yuguo Chen, Chuanbao Li
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Journal European Heart Journal Acute Cardiovascular Care
Year 2026
DOI
10.1093/ehjacc/zuag130
URL
https://doi.org/10.1093/ehjacc/zuag130
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