{
  "abstract": "Background: Acute decompensated aortic stenosis (ADAS) carries high mortality, but the optimal timing of valve intervention is unknown. Objective: To assess the association between time to valve intervention (transcatheter aortic valve replacement [TAVR] or balloon aortic valvuloplasty [BAV]) and clinical outcomes in ADAS. Methods: Embase, Ovid MEDLINE and CENTRAL were searched to May 15, 2026. Hazard ratios (HRs) for delayed versus earlier intervention were pooled using random-effects models with modified Hartung-Knapp inference. Unadjusted short-term mortality risk ratios (RRs) were pooled using the Mantel-Haenszel method. Results: Eight observational cohort studies (n=6,044) met inclusion criteria: six TAVR (n= 5,986) and two BAV (n=58) studies. Patients were approximately 79 years old, and 63% were male. Early-intervention thresholds ranged from <24-48 hours (BAV) to ?22 days (TAVR) from admission. Delayed intervention was not significantly associated with long-term all-cause mortality (HR 1.52, 95% CI 0.46-5.00; p=0.269; I2=58.2%) or mortality per five-day delay (HR 1.09, 95% CI 0.34-3.43; p=0.530; I2=86.7%). Crude short-term mortality was higher with delayed intervention (RR 4.96, 95% CI 1.17-20.92; p=0.029; I2=0.0%), although this association was not robust to sensitivity analyses. Most studies were at serious risk of bias, with substantial heterogeneity in clinical severity, intervention timing, and treatment modality. Conclusion: Point estimates favour earlier intervention, but current observational data do not establish a mortality benefit for an optimal door-to-valve interval, and existing study designs are biased against early treatment. Prospective and randomized-controlled trials on optimal valve intervention timing following ADAS are needed.",
  "abstract_shown": true,
  "affiliations": [
    "The Royal Melbourne Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "name": "J. R. Ma"
    },
    {
      "name": "M. Gerges"
    },
    {
      "name": "A. Koshy"
    },
    {
      "name": "W. Wilson"
    },
    {
      "name": "A. Taylor"
    },
    {
      "affs": [
        0
      ],
      "name": "W. Chan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ergaf315zbk1x.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.03.26367226",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367226v1.full",
  "id": "ergaf315zbk1x",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367226v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367226v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ergaf315zbk1x.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T00:21:02Z",
      "native_id": "10.64898/2026.11.03.26367226",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367226v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Door-to-Valve Time and Clinical Outcomes in Acute Decompensated Severe Aortic Stenosis: Systematic Review and Meta-Analysis",
  "title_text": "Door-to-Valve Time and Clinical Outcomes in Acute Decompensated Severe Aortic Stenosis: Systematic Review and Meta-Analysis",
  "type": "preprint",
  "updated_at": "2026-11-07T00:20:51Z",
  "url": "https://research.draconitic.com/paper/ergaf315zbk1x",
  "venue": "medRxiv",
  "versions": []
}