Kotaro Takahashi, Yasuaki Takeji, Tomohiko Taniguchi, Takeshi Morimoto, Shinichi Shirai, Takeshi Kitai, Hiroyuki Tabata, Nobuhisa Ohno, Ryosuke Murai, Kohei Osakada, Koichiro Murata, Masanao Nakai, Hiroshi Tsuneyoshi, Tomohisa Tada, Masashi Amano, Shin Watanabe, Hiroki Shiomi, Hirotoshi Watanabe, Yusuke Yoshikawa, Ryusuke Nishikawa, Yuki Obayashi, Ko Yamamoto, Mamoru Toyofuku, Shojiro Tatsushima, Norio Kanamori, Makoto Miyake, Hiroyuki Nakayama, Kazuya Nagao, Masayasu Izuhara, Kenji Nakatsuma, Moriaki Inoko, Takanari Fujita, Masahiro Kimura, Mitsuru Ishii, Shunsuke Usami, Fumiko Nakazeki, Kiyonori Togi, Yasutaka Inuzuka, Kenji Ando, Tatsuhiko Komiya, Koh Ono, Kenji Minatoya, Takeshi Kimura, Current as Registry-2 Investigators
The clinical trials in low risk patients have clearly demonstrated clinical outcomes of transcatheter aortic-valve replacement (TAVR) comparable to those of surgical aortic-valve replacement (SAVR) in patients with severe aortic stenosis (AS). However, data are lacking on the appropriate treatment selection for patients with severe AS and low surgical risk in Japanese routine clinical practice. Among 3369 patients enrolled in the CURRENT AS Registry-2 between April 2018 and December 2020, the current study population include 826 patients with low Society of Thoracic Surgeons (STS) score and not on hemodialysis who actually underwent TAVR (439 patients) or SAVR (387 patients). After propensity score matching, there remained 162 patients in each group. The primary outcome was a composite of all-cause death, disabling stroke, or heart failure hospitalization. The cumulative 3-year incidence of the primary outcome was not significantly different between the TAVR and SAVR groups (19.5% and 17.4%, P = 0.82). Even after adjusting for age and institution, there was no excess risk of TAVR relative to SAVR for the primary outcome (adjusted HR: 1.05, 95% CI: 0.50-2.20, P = 0.91). In low-risk patients with severe AS, TAVR compared to SAVR was associated with comparable clinical outcomes for a composite of all-cause death, disabling stroke and heart failure hospitalization.