Mortality after urgent versus elective transcatheter aortic valve replacement: a systematic review and meta-analysis using reconstructed individual patient data from Kaplan–Meier curves
- Open Access
- 13-12-2025
- Aortic Valve Replacement
- Systematic Review
Published in:
- Authors
- Mohammadreza Babaei
- Parisa Fallahtafti
- Negin Sadat Hosseini Mohammadi
- Alireza Azarboo
- Amirhossein Habibzadeh
- Amirali Azizpour
- Sina Rashedi
- Jishanth Mattumpuram
- Amr Mohsen
- Zahra Hosseini
- Hamidreza Soleimani
- Dhaval Kolte
- Published in
- BMC Cardiovascular Disorders | Issue 1/2026
Abstract
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.
Graphical abstract
Survival analysis comparing urgent vs. elective TAVR demonstrates significantly higher mortality in the urgent group within the first year (HR 1.96; 95% CI 1.85–2.08; p < 0.001). Beyond 1 year, no significant difference in survival was observed between groups (HR 1.01; 95% CI 0.84–1.22; p = 0.83).
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- Title
- Mortality after urgent versus elective transcatheter aortic valve replacement: a systematic review and meta-analysis using reconstructed individual patient data from Kaplan–Meier curves
- Authors
-
Mohammadreza Babaei
Parisa Fallahtafti
Negin Sadat Hosseini Mohammadi
Alireza Azarboo
Amirhossein Habibzadeh
Amirali Azizpour
Sina Rashedi
Jishanth Mattumpuram
Amr Mohsen
Zahra Hosseini
Hamidreza Soleimani
Dhaval Kolte
- Publication date
- 13-12-2025
- Publisher
- BioMed Central
- Published in
-
BMC Cardiovascular Disorders / Issue 1/2026
Electronic ISSN: 1471-2261 - DOI
- https://doi.org/10.1186/s12872-025-05424-x
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