Hospital procedural costs of surgical aortic valve replacement versus transcatheter aortic valve replacement in low-risk isolated aortic stenosis: a single-center analysis in japan.

OBJECTIVES

The indications for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) are gradually expanding in Japan, with insurance coverage for low-risk patients approved in 2021. Although some reports have compared procedural costs, data addressing low-risk populations remain limited. This study aimed to assess in-hospital costs and outcomes of isolated TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients with AS in real-world practice in Japan.

METHODS

We retrospectively analyzed 128 low-risk (Society of Thoracic Surgeons [STS] score < 4%) patients with AS who underwent isolated TAVR (n = 80) or SAVR (n = 48) between August 2021 and December 2024 at The University of Osaka Hospital.

RESULTS

Both groups achieved excellent outcomes, with no in-hospital or 30-day mortality. Patients who underwent TAVR had shorter intensive care unit (ICU) stays (1 [1-1] vs. 3 [2-4] days) and shorter postoperative stays (7 [5-11] vs. 14 [11-18] days). However, total in-hospital and combined operative plus postoperative costs were significantly higher for TAVR (5.62 vs. 5.11 million Japanese Yen (JPY), p < 0.0001), (5.29 million vs. 4.80 million JPY, p = 0.0002).

CONCLUSIONS

In this cohort of low-risk patients with AS in Japan, TAVR was associated with significantly higher in-hospital costs than SAVR, despite shorter postoperative stay.