Nationwide trends and in-hospital outcomes of surgical versus transcatheter aortic valve replacement in Japan: a real-world analysis using administrative data.

Aortic stenosis (AS) is the most prevalent valvular disease in developed nations. Transcatheter Aortic Valve Replacement (TAVR) offers a minimally invasive alternative to Surgical Aortic Valve Replacement (SAVR), particularly for high-risk patients. However, TAVR adoption and outcomes in Japan remain understudied due to limited national database analyses and differences in patient demographics compared to major international trials. We conducted a retrospective cohort study of aortic valve replacement (AVR) procedures from 2014 to 2021 using the National Healthcare Reimbursement database. In total, 103,076 cases were analyzed, with 33,881 undergoing TAVR and 31,337 undergoing SAVR for aortic stenosis. TAVR patients were older (median age 85 vs. 76 years, p < 0.0001) and more often female (66.7% vs. 51.4%, p < 0.0001). TAVR was associated with lower in-hospital mortality (0.88% vs. 2.4%, p < 0.0001), shorter hospital stays (14 vs. 24 days, p < 0.0001), but significantly higher medical costs (¥5,303,722 vs. ¥3,945,622, p < 0.0001). Among patients younger than 75 years, no significant difference in mortality was observed. In this nationwide administrative database, TAVR was associated with lower in-hospital mortality and shorter hospital stays compared to SAVR, though at a higher cost. While patient backgrounds and clinical risks could not be fully adjusted due to data limitations, the observed differences in in-hospital outcomes between TAVR and SAVR reflect real-world practice patterns. These findings should be interpreted as descriptive, not causal. The absence of a mortality difference in patients under 75 years highlights the need for further evaluation of TAVR's long-term effectiveness and cost-efficiency in younger populations.