Background/Objectives: Pleural effusions may be seen in patients with severe AS complicated by hemodynamically significant heart failure. However, there are no data on the association between pleural effusion and long-term mortality in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess the impact of pre-procedural pleural effusion on long-term mortality in these patients. Methods: A retrospective, single-center analysis was conducted on 401 patients who underwent TAVI between January 2010 and December 2023. The patients were categorized into two groups based on the presence of pleural effusion, which was assessed via pre-procedural imaging using thoracic computed tomography (CT). Results: Pleural effusion was present in 158 patients (39.4%). The patients with pleural effusion had significantly higher long-term mortality rates compared to those without pleural effusion (46.2% vs. 24.3%, p < 0.001). Multivariate analysis identified pleural effusion as an independent predictor of long-term mortality (HR: 1.568, 95% CI: 1.065–2.308, p = 0.023). Also, the patients with pleural effusions had a higher long-term mortality rate compared with those without pleural effusions (log-rank p < 0.001). Conclusions: Pre-procedural pleural effusion is independently associated with increased long-term mortality in TAVI patients. Early recognition and management of pleural effusion are critical for optimizing outcomes in this high-risk population.

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality after TAVI using advanced survival analyses. Methods: We retrospectively analyzed 381 consecutive patients who underwent transfemoral TAVI between December 2016 and October 2024 at two tertiary cardiovascular centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. The primary outcome was all-cause mortality. Patients were categorized into AKI and non-AKI groups. Clinical outcomes, including 30-day, 1-year, and overall mortality, were evaluated. Results: Among 381 patients who underwent TAVI, 59 (15.5%) developed AKI according to the AKIN criteria. During a 33.9 months (18.0–59.2) median follow-up of overall mortality was significantly higher in the AKI group compared with those without AKI. In the multivariate Cox regression analysis, AKI was significantly associated with long-term mortality (HR: 2.07, 95% CI 1.32–3.25; p = 0.002). The time-varying hazard ratio curve demonstrated that the excess mortality risk associated with AKI was most pronounced in the early period and gradually declined thereafter. In time-interval–specific analyses, AKI was strongly associated with mortality within the first month (HR 6.30, 95% CI 3.03–13.08, p < 0.001) and remained significant up to 12 months (HR 2.18, 95% CI 1.32–3.59, p = 0.002). Beyond the first year, this association attenuated and lost statistical significance at 12–36 months (HR 0.90, p = 0.79), 36–60 months (HR 0.57, p = 0.24), and >60 months (HR 0.43, p = 0.13). Conclusions: AKI is an important predictor of early and mid-term mortality following TAVI, but its long-term prognostic impact is less pronounced. Preventive strategies and early management of AKI may improve outcomes in this high-risk population.

Background: The optimal anesthesia strategy for transfemoral transcatheter aortic valve implantation (TAVI) remains uncertain. We evaluated the impact of local anesthesia, conscious sedation, and general anesthesia on early and long-term outcomes after TAVI. Methods: This single-center cohort included 401 patients undergoing transfemoral TAVI with local anesthesia (LA, n = 77), conscious sedation (CS, n = 147), or general anesthesia (GA, n = 177). Outcomes were assessed using hierarchical win-ratio analysis prioritizing mortality over major adverse cardiovascular and cerebrovascular events (MACCE), supported by Kaplan–Meier and restricted mean survival time analyses. Sensitivity analyses using inverse probability of treatment weighting (IPTW) were performed to account for baseline differences between groups. Results: Baseline comorbidities were broadly comparable, although GA patients had higher-risk anatomical and procedural features. In unadjusted win-ratio analyses, LA showed a significant advantage over GA at 0–6 months (win ratio [WR] 1.79; 95% CI 1.10–2.93; p = 0.020). After multivariable adjustment, LA remained superior to GA at 6–12 and 12–24 months (adjusted WR 1.67 and 1.56, both p < 0.05). One-year mortality differed significantly among groups (p = 0.012). RMST analysis demonstrated a cumulative survival advantage for LA versus GA, reaching 6.6 months at 60 months. MACCE-free survival was largely comparable across strategies. However, in IPTW-weighted analyses, anesthesia type was not independently associated with mortality or MACCE. Conclusions: Minimally invasive anesthesia strategies were associated with more favorable early survival patterns after transfemoral TAVI in primary analyses. However, after adjustment for baseline differences using IPTW, anesthesia type was not independently associated with mortality or MACCE. These findings suggest that apparent outcome differences may partly reflect underlying patient risk profiles rather than a purely causal effect of anesthesia strategy.