• Tomohiko Taniguchi, Takeshi Morimoto, Hiroki Shiomi, Kenji Ando, Norio Kanamori, Koichiro Murata, Takeshi Kitai, Yuichi Kawase, Chisato Izumi, Makoto Miyake, Hirokazu Mitsuoka, Masashi Kato, Yutaka Hirano, Shintaro Matsuda, Tsukasa Inada, Kazuya Nagao, Tomoyuki Murakami, Yasuyo Takeuchi, Keiichiro Yamane, Mamoru Toyofuku, Mitsuru Ishii, Eri Minamino-Muta, Takao Kato, Moriaki Inoko, Tomoyuki Ikeda, Akihiro Komasa, Katsuhisa Ishii, Kozo Hotta, Nobuya Higashitani, Yoshihiro Kato, Yasutaka Inuzuka, Chiyo Maeda, Toshikazu Jinnai, Yuko Morikami, Naritatsu Saito, Kenji Minatoya, Takeshi Kimura, and CURRENT AS Registry Investigators.
• From the Department of Cardiovascular Medicine (T.T., H.S., S.M., E.M.-M., T. Kato, N.S., T. Kimura) and Department of Cardiovascular Surgery (K. Minatoya), Kyoto University Graduate School of Medicine, Japan; Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Kokura Memorial Hospital, Kitakyushu, Japan (K.A.); Shimada Municipal Hospital, Japan (N.K.); Shizuoka City Shizuoka Hospital, Japan (K. Murata); Kobe City Medical Center General Hospital, Japan (T.K.); Kurashiki Central Hospital, Japan (Y.K.); Tenri Hospital, Japan (C.I., M.M.); Kindai University, Nara Hospital, Higashiosaka, Japan (H.M.); Mitsubishi Kyoto Hospital, Kyoto, Japan (M.K.); Kindai University Hospital, Higashiosaka, Japan (Y.H.); Osaka Red Cross Hospital, Japan (T.I., K.N.); Koto Memorial Hospital, Higashiomi, Japan (T. Murakami); Shizuoka General Hospital, Japan (Y.T.); Nishikobe Medical Center, Kobe, Japan (K.Y.); Japanese Red Cross Wakayama Medical Center, Japan (M. T.); National Hospital Organization Kyoto Medical Center, Japan (M. Ishii); Kitano Hospital, Osaka, Japan (M. Inoko); Hikone Municipal Hospital, Japan (T.I.); Kansai Electric Power Hospital, Japan (A.K., K.I.); Hyogo Prefectural Amagasaki General Medical Center, Japan (K.H.); Japanese Red Cross Otsu Hospital, Japan (N.H., T.J.); Saiseikai Noe Hospital, Osaka, Japan (Y.K.); Shiga Medical Center for Adults, Moriyama, Japan (Y.I.); Hamamatsu Rosai Hospital, Japan (C.M.); and Hirakata Kohsai Hospital, Japan (Y.M.).
• Circ Cardiovasc Interv. 2017 May 1; 10 (5).

BackgroundThere is considerable debate on the management of patients with low-gradient severe aortic stenosis (LG-AS), defined as aortic valve area <1 cm2 with peak aortic jet velocity ≤4.0 m/s, and mean aortic pressure gradient ≤40 mm Hg.Methods And ResultsIn the CURRENT AS registry (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis), there were 2097 patients (initial aortic valve replacement [AVR] strategy: n=977, and conservative strategy: n=1120) with high-gradient severe aortic stenosis (HG-AS) and 1712 patients (initial AVR strategy: n=219, and conservative strategy: n=1493) with LG-AS. AVR was more frequently performed in HG-AS patients than in LG-AS patients (60% versus 28%) during the entire follow-up. In the comparison between the initial AVR and conservative groups, the propensity score-matched cohorts were developed in both HG-AS (n=887 for each group) and LG-AS (n=218 for each group) strata. The initial AVR strategy when compared with the conservative strategy was associated with markedly lower risk for a composite of aortic valve-related death or heart failure hospitalization in both HG-AS and LG-AS strata (hazard ratio, 0.30; 95% confidence interval, 0.25-0.37; P<0.001 and hazard ratio, 0.46; 95% confidence interval, 0.32-0.67; P<0.001, respectively). Among 1358 patients with LG-AS with preserved left ventricular ejection fraction, the initial AVR strategy was associated with a better outcome than the conservative strategy (adjusted hazard ratio, 0.37; 95% confidence interval, 0.23-0.59; P<0.001).ConclusionsThe initial AVR strategy was associated with better outcomes than the conservative strategy in both HG-AS and LG-AS patients, although AVR was less frequently performed in LG-AS patients than in HG-AS patients. The favorable effect of initial AVR strategy was also seen in patients with LG-AS with preserved left ventricular ejection fraction.Clinical Trial RegistrationURL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000012140.© 2017 American Heart Association, Inc.

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