AsiaIntervention. 2026 Oct 23;12(3):181-190. doi: 10.4244/AIJ-D-26-00018. eCollection 2026 Oct.
ABSTRACT
BACKGROUND: The number of transcatheter aortic valve implantation (TAVI) procedures is increasing worldwide. However, studies comparing regional differences remain scarce.
AIMS: This study aimed to compare clinical outcomes after TAVI between Japan and France using a database compiled from two large hospitals.
METHODS: The TOTO-TAVI study included patients who underwent TAVI in Japan and France. The primary endpoint was in-hospital death. Periprocedural safety outcomes and 3-year all-cause mortality were also evaluated. A subgroup analysis was performed to assess the independent TAVI risk for each country.
RESULTS: Among 6,967 patients who underwent TAVI between 2016 and 2024, 1,422 in Japan and 4,771 in France were included. Although patients in Japan showed a significantly smaller body size, a smaller aortic valve, and a higher operative risk than those in France, the in-hospital death rate was comparable between the two groups (0.6% vs 1.3%; p=0.068). The new pacemaker implantation rate was lower in Japan than in France. There was no significant difference in 3-year all-cause mortality between Japan and France (22.5% vs 23.5%, hazard ratio 0.678, 95% confidence interval: 0.114-4.033; p=0.583). For the subgroup analysis, there were no statistically significant independent risk factors for composite outcomes, including in-hospital death, stroke, and bleeding, in Japan; however, in France, female sex, higher body mass index, lower haemoglobin levels, previous coronary artery bypass grafting and cerebrovascular disease, bicuspid annulus, and general anaesthesia were independent risk factors.
CONCLUSIONS: Despite differences in patient backgrounds, in-hospital and 3-year mortality were comparable between Japan and France, suggesting that procedural safety and medium-term prognosis after TAVI were established regardless of procedural risks.
PMID:42923759 | PMC:PMC13689730 | DOI:10.4244/AIJ-D-26-00018