AsiaIntervention
Differences between Japan and France in transcatheter aortic valve implantation: insights from the TOTO-TAVI study
By Iwata J, Hayashida K, Arow Z and 8 others.
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.