Aortic StenosisAMETHYSTNCT06924151
Isolated Surgical Aortic Valve Replacement in Low Risk AS Patients
A study testing surgical aortic valve replacement and Transcatheter aortic valve replacement in people with Aortic Stenosis, run by Osaka University at 37 sites in Japan.
Trial summary
To establish the safety and effectiveness of surgical aortic valve replacement (SAVR) in patients with isolated severe, calcific aortic stenosis who are at low surgical risk. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Aortic Stenosis
- What is being tested?
- surgical aortic valve replacement and Transcatheter aortic valve replacement
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 450 participants
- Where
- 37 sitesJapan
- Study dates
- 1 Jun 2025to 31 May 2040
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- All study participants must meet the following inclusion criteria 1. Severe, calcific aortic stenosis with the following criteria:
- Jet velocity ≥4.0 m/s or mean gradient ≥ 40 mmHg OR
- AVA ≤1.0 cm2 or AVA index ≤ 0.6 cm2/m2 Note: Qualifying TTE must be within 90 days prior to randomization
- AND 2. NYHA class ≥ II OR Exercisee test that demonstrates a limited exercise capacity, abnormal blood pressure response, or arrhythmia OR Asymptomatic patients with LVEF <50%
- The Heart Team agrees that the surgical mortality risk is less than 4% according to STS-PROM. The Heart Team's assessment should include evaluation of overall clinical status and comorbidities that may not be adequately captured by risk calculators such as STS-PROM, in addition to the risk score itself.
- The patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent as approved by certified review board.
Who cannot join
- Candidates will be excluded from the study if any of the following conditions are present:
- History of cardiovascular surgery or thoracotomy
- Pre-existing other valvular disease, coronary artery disease or aortic disease required intervention Note: interventions for arrhythmia or root enlargement are not considered exclusionary.
- Heart Team assessment that chest abnormalities or significant frailty would prevent safe SAVR.
- Native aortic annulus size unsuitable for sizes the currently approved and marketed SAVR or TAVR based on preoperative 3D-CT image analysis.
- Iliofemoral vessel characteristics that whould preclude safe insertion of the introducer sheath.
Show all 36Show fewer
- Evidence of an acute myocardial infarction or PCI ≤ 30 days before randomization
- Aortic valve is unicuspid
- Severe aortic regurgitation (>3+)
- Severe mitral regurgitation (>3+) or ≥ moderate stenosis
- Severe tricuspid regurgitation (>3+) or ≥ moderate stenosis
- Pre-existing mechanical or bioprosthetic valve in any position.
- Complex coronary artery disease:
- Heart Team assessment that CABG is recommended at the time of SAVR
- Heart Team assessment that optimal revascularization cannot be performed
- Symptomatic carotid or vertebral artery disease or treatment of carotid stenosis within 30 days of randomization
- Leukopenia (WBC < 3000 cell/mL), Thrombocytopenia (Plt < 50,000 cell/mL), history of bleeding diathesis or coagulopathy.
- Hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation or mechanical heart assistance within 30 days of randomization
- Hypertrophic cardiomyopathy with obstruction (HOCM)
- Ventricular dysfunction with LVEF < 30%
- Cardiac imaging (echo, CT, and/or MRI) evidence of intracardiac mass, thrombus or vegetation
- Inability to tolerate or condition precluding treatment with antithrombotic/anticoagulation therapy during or after the valve implant procedure
- Stroke or transient ischemic attack (TIA) within 90 days of randomization
- Renal insufficiency (eGFR < 30 ml/min per the Cockcroft-Gault formula) and/or renal replacement therapy
- Active bacterial endocarditis within 180 days of randomization
- Severe lung disease (FEV1 < 50% predicted) or currently on home oxygen
- Severe pulmonary hypertension (e.g., PA systolic pressure ≥ 2/3 systemic pressure)
- History of cirrhosis or active liver disease
- Significant abdominal or thoracic aortic disease (such as porcelain aorta, aneurysm, severe calcification, aortic coarctation, etc.) that would preclude cannulation and aortotomy for SAVR or safe passage of the delivery system for TAVR.
- Patient refuses blood products.
- BMI > 50 kg/m2
- Estimated life expectancy < 24 months.
- Absolute contraindications or allergy to iodinated contrast that cannot be adequately treated with pre-medication.
- Immobility or significant cognitive impairment that would prevent completion of study procedure.
- Currently participating in an investigational drug or another device study.
- Unsuitable as candidates by the principal investigator or a research associate for other reasons
Trial locations and contacts
37 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Shigeru Miyagawa, M.D. contact
37 sites in 1 country
Japan37 sites, 37 recruiting
- Recruiting
Kansai Rosai Hospital
Amagasaki
Mutsunori Kitahara, M.D., 81-6-6416-1221, mkitahara119@gmail.com
Mutsunori Kitahara, M.D.
- Recruiting
Sakakibara Heart Institute
Fuchū, Tokyo, 1830003
Tomohiro Iwakura, M.D., +81423143111, tomalex5050@gmail.com
Tomohiro Iwakura, M.D.
- Recruiting
Kyushu Univerisity
Fukuoka, 8128582
Akira Shiose, M.D., +81926411151, shiose.akira.799@m.kyushu-u.ac.jp
Akira Shiose, M.D.
- Recruiting
Seirei Hamamatsu General Hospital
Hamamatsu, Shizuoka, 4308558
Masaaki Koide, M.D., +81534742222, mkoide@sis.seirei.or.jp
Masaaki Koide, M.D.
- Recruiting
Hamamatsu University Shool of Medicine
Hamamatsu, Shizuoka, 4313192
Kazuma Okamoto, M.D., +81534352111, okamoto@hama-med.ac.jp
Kazuma Okamoto, M.D.
- Recruiting
Saitama Medical University International Medical Center
Hidaka, Saitama, 3501298
Akihiro Yoshitake, M.D., +81429844111, akihiro197253@yahoo.co.jp
Akihiro Yoshitake, M.D.
- Recruiting
Tokai University
Isehara, Kanagawa, 2591193
Yohei Ohno, M.D., +81463931121, yohno@tokai.ac.jp
Yohei Ohno, M.D.
- Recruiting
Shonan Kamakura General Hospital
Kamakura, Kanagawa, 2478533
Shigeru Saito, M.D., +81467461717, transradial@kamakuraheart.org
Shigeru Saito, M.D.
- Recruiting
Kawasakisaiwai Hospital
Kawasaki, Kanagawa, 2120014
Shuichiro Takanashi, M.D., +81445444611, s0715t@gmail.com
Shuichiro Takanashi, M.D.
- Recruiting
St.Marianna University School of Medicine
Kawasaki, Kanagawa, 2168511
Kan Nawata, M.D., +81449778111, kan.nawata@marianna-u.ac.jp
Kan Nawata, M.D.
- Recruiting
Kishiwada Tokusyukai Hospital
Kishiwada, Osaka, 5960042
Satoshi Kuroyanagi, M.D., +81724459915, satoshi_5023@yahoo.co.jp
Satoshi Kuroyanagi, M.D.
- Recruiting
Kokura Memorial Hospital
Kitakyushu, Fukuoka, 802-8555
Shinichi Shirai, M.D., +81935112000, shirai440130@gmail.com
Shinichi Shirai, M.D.
- Recruiting
Chikamori Hospital
Kochi, 7808522
Hiroyuki Irie, M.D., +81888225231, irie@chikamori.com
Hiroyuki Irie, M.D.
- Recruiting
Kumamoto University
Kumamoto, 8608556
Kenichi Tsujita, M.D., +81963735025, tsujita@kumamoto-u.ac.jp
Kenichi Tsujita, M.D.
- Recruiting
Kurume University
Kurume, Fukuoka, 8300011
Tohru Takaseya, M.D., +81942353311, ttakaseya@kurume-u.ac.jp
Tohru Takaseya, M.D.
- Recruiting
New Tokyo Hospital
Matsudo, Chiba, 2402232
Tatsuya Nakao, M.D., +81-47-711-8700, data-management@shin-tokyohospital.or.jp
Tatsuya Nakao, M.D.
- Recruiting
Chibanishi General Hospital
Matsudo, Chiba, 2702251
Yoshitsugu Nakamura, M.D., +81473848111, ystgnkmr@gmail.com
Yoshitsugu Nakamura, M.D.
- Recruiting
Shinshu University
Matsumoto, Nagano, 3908621
Tatsuichiro Seto, M.D., +81570003010, seto@shinshu-u.ac.jp
Tatsuichiro Seto, M.D.
- Recruiting
Nagasaki University
Nagasaki, 8528501
Takashi Miura, M.D., +81958197200, takashirsa@nagasaki-u.ac.jp
Takashi Miura, M.D.
- Recruiting
Niigata University Medical and Dental Hospital
Niigata, 951-8520
Makoto Hoyano, M.D., 025-223-6161, mhoyano@med.niigata-u.ac.jp
Makoto Hoyano, M.D.
- Recruiting
Hyogo Medical University
Nishinomiya, Hyōgo, 6638501
Kenichi Watanabe, M.D., +817989456111, kenichi217@yahoo.co.jp
Kenichi Watanabe, M.D.
- Recruiting
Oita University
Ōita, Yufu, 879-5593
Takashi Syuto, M.D., +8197-549-4411, shutot@oita-u.ac.jp
Takashi Syuto, M.D.
- Recruiting
The Sakakibara Heart Institute of Okayama
Okayama, 7000804
Arudo Hiraoka, M.D., 81862257111, bassbord1028@yahoo.co.jp
Arudo Hiraoka, M.D.
- Recruiting
Osaka International Medical and Science Center
Osaka, 5438922
Yoshiki Sawa, M.D., +81667716051, yshksw2@gmail.com
Yoshiki Sawa, M.D.
- Recruiting
Osaka General Medical Center
Osaka, 558-8558
Naosumi Sekiya, M.D., 06-6692-1201, sekiyan73@gmail.com
Naosumi Sekiya, M.D.
- Recruiting
National Hospital Organization Osaka National Hospital
Osaka
Tetsuya Saito, M.D., 81-6-6942-1331, saito.tetsuya.nj@mail.hosp.go.jp
Tetsuya Saito, M.D.
- Recruiting
Osaka Rosai Hospital
Sakai, Osaka, 591-8025
Haruhiko Kondoh, M.D., 072-252-3561, haruhk@wa3.so-net.ne.jp
Haruhiko Kondoh, M.D.
- Recruiting
Kinki University Hospital
Sayama, Osaka, 589-8511
Gaku Nakazawa, M.D., +8172366-0221, gnakazawa@med.kindai.ac.jp
Gaku Nakazawa, M.D.
- Recruiting
Dokkyo Medical University
Shimotsuga, Tochigi, 3210293
Masashi Kawamura, M.D., +81282861111, m-kawamura129@dokkyomed.ac.jp
Masashi Kawamura, M.D.
- Recruiting
Tokyo Women's Medical University
Shinjuku, Tokyo, 1628666
Hiroshi Niinami, M.D., +81333538111, hniinami@twmu.ac.jp
Hiroshi Niinami, M.D.
- Recruiting
Shizuoka General Hospital
Shizuoka, 4208527
Hiroshi Tsuneyoshi, M.D., +8154-247-6111, tuneyosi_ca@yahoo.co.jp
Hiroshi Tsuneyoshi, M.D.
- Recruiting
National cerebral and cardiovascular center
Suita
Satsuki Fukushima, M.D., 81-6-6170-1070, s.fukushima@ncvc.go.jp
Satsuki Fukushima, M.D.
- Recruiting
Tokushima University
Tokushima, 7708503
Hiroki Hata, M.D., +8188-631-3111, hatahiro@tokushima-u.ac.jp
Hiroki Hata, M.D.
- Recruiting
Yuuai Medical Center
Tomigusuku, Okinawa, 9010224
Akihiko Yamauchi, 0988503811, yamauchi4964@gmail.com
Akihiko Yamauchi, M.D.
- Recruiting
Tokyo Bay Urayasu Ichikawa Medical Center
Urayasu, Chiba, 2790001
Kunihiko Yoshino, M.D., +8147-351-3101, kyoshino36@gmail.com
Kunihiko Yoshino, M.D.
- Recruiting
Wakayama Medical University
Wakayama, 6418509
Kentaro Honda, M.D., +81734472300, honda-k@wakayama-med.ac.jp
Kentaro Honda, M.D.
- Recruiting
Tottori University
Yonago, Tottori, 6838504
Yasushi Yoshikawa, M.D., +81859331111, yoshikawa@tottori-u.ac.jp
Yasushi Yoshikawa, M.D.
About this study
Official title: the Prospective, Randomized, Controlled, Multi-center Study to Establish the Safety and Effectiveness of Isolated Surgical Aortic Valve Replacement in Low Risk Patients Who Have Symptomatic Severe Aortic Stenosis
To establish the safety and effectiveness of surgical aortic valve replacement (SAVR) in patients with isolated severe, calcific aortic stenosis who are at low surgical risk.
Read the detailed description
This study is the Prospective, Randomized, Controlled, Multi-center Study of Isolated SAVR in Low Risk AS Patients (The AMETHYST trial). Patients will be randomized 1:1 to receive either SAVR or transcatheter heart valve replacement (TAVR) with a commercially available surgical and transcatheter bioprosthetic valves. The aim of this study was to assess the non-inferiority of SAVR compared with TAVR for the combined endpoints of death from any cause, stroke and rehospitalization (hospitalization related to biological valves or procedures or heart failure) at 1 year postoperatively. Patients will be seen for follow-up visits at discharge, 30 days, and annually through 10 years.
- Conditions
- Aortic Stenosis
- Being tested
- surgical aortic valve replacement, Transcatheter aortic valve replacement
- Medical subject headings
- Aortic Valve Stenosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
surgical aortic valve replacementProcedure or surgery
SAVR
Transcatheter aortic valve replacementProcedure or surgery
TAVR
| Study group | Role | What they receive |
|---|---|---|
| Surgical aortic valve replacement | Experimental | Surgical aortic valve replacement (SAVR) with free choice of surgical bioprosthesis and free choice of surgical access according to the surgeon's preference Receives: Procedure: surgical aortic valve replacement |
| Transcatheter aortic valve replacement | Active comparator | Transcatheter aortic valve replacement (TAVR) using the device available in Japan in facilities approved to perform TAVR. Receives: Procedure: Transcatheter aortic valve replacement |
What is being measured
The primary outcome is the main question the study is designed to answer.
Composite endpoint of all-cause mortality, all stroke, and rehospitalization (valve-related or procedure-related and including heart failure)
Measured: at 1 year post procedure
Secondary outcomes (14)
the rate of all-cause mortality or disabling stroke
Measured: at one year
the rate of all-cause mortality
Measured: at one year
the rate of all stroke
Measured: at one year
the rate of disabling stroke
Measured: at one year
the rate of rehospitalization (valve-related or procedure-related and including heart failure)
Measured: at one year
the rate of new bundle branch block or new pacemaker implantation
Measured: at one year
the rate of new onset of atrial fibrillation
Measured: at 30 days
the rate of life-threatening bleeding
Measured: at one year
the rate of occurrence of perivalvular regurgitation ≥ mild by echocardiography
Measured: at one year
Quality of life as assessed by KCCQ
Measured: at one year
Quality of life as assessed by EQ-5D-5L
Measured: at one year
the rate of prosthetic valve endocarditis
Measured: at one year
the rate of prosthetic valve thrombosis
Measured: at one year
the rate of valve-related dysfunction requiring repeat procedure
Measured: at one year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Apr 2025
- Study start1 Jun 2025
- Primary completion31 May 2031 (estimated)
- Study completion31 May 2040 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Aortic StenosisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 450 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Osaka University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06924151
- Sponsor's protocol ID
- AMETHYST-001
- Acronym
- AMETHYST
- Status last verified
- Jun 2026
- First submitted
- 11 Feb 2025
- Last updated
- 4 Sep 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- the Prospective, Randomized, Controlled, Multi-center Study to Establish the Safety and Effectiveness of Isolated Surgical Aortic Valve Replacement in Low Risk Patients Who Have Symptomatic Severe Aortic Stenosis
- ClinicalTrials.gov ID
- NCT06924151
- Acronym / sponsor ID
- AMETHYST / AMETHYST-001
- Conditions
- Aortic Stenosis
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 450 participants (estimated)
- Lead sponsor
- Osaka UniversityUniversity, hospital or other
- Study start
- 1 Jun 2025 (actual)
- Primary completion
- 31 May 2031 (estimated)
- Study completion
- 31 May 2040 (estimated)
- First posted
- 11 Apr 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To establish the safety and effectiveness of surgical aortic valve replacement (SAVR) in patients with isolated severe, calcific aortic stenosis who are at low surgical risk.
Detailed description
This study is the Prospective, Randomized, Controlled, Multi-center Study of Isolated SAVR in Low Risk AS Patients (The AMETHYST trial). Patients will be randomized 1:1 to receive either SAVR or transcatheter heart valve replacement (TAVR) with a commercially available surgical and transcatheter bioprosthetic valves. The aim of this study was to assess the non-inferiority of SAVR compared with TAVR for the combined endpoints of death from any cause, stroke and rehospitalization (hospitalization related to biological valves or procedures or heart failure) at 1 year postoperatively. Patients will be seen for follow-up visits at discharge, 30 days, and annually through 10 years.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Surgical aortic valve replacement | Experimental | Procedure: surgical aortic valve replacementSurgical aortic valve replacement (SAVR) with free choice of surgical bioprosthesis and free choice of surgical access according to the surgeon's preference |
| Transcatheter aortic valve replacement | Active comparator | Procedure: Transcatheter aortic valve replacementTranscatheter aortic valve replacement (TAVR) using the device available in Japan in facilities approved to perform TAVR. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (6 listed)
- All study participants must meet the following inclusion criteria 1. Severe, calcific aortic stenosis with the following criteria:
- AND 2. NYHA class ≥ II OR Exercisee test that demonstrates a limited exercise capacity, abnormal blood pressure response, or arrhythmia OR Asymptomatic patients with LVEF <50%
- The Heart Team agrees that the surgical mortality risk is less than 4% according to STS-PROM. The Heart Team's assessment should include evaluation of overall clinical status and comorbidities that may not be adequately captured by risk calculators such as STS-PROM, in addition to the risk score itself.
- The patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent as approved by certified review board.
Key exclusion criteria (36 listed)
- Candidates will be excluded from the study if any of the following conditions are present:
- History of cardiovascular surgery or thoracotomy
- Pre-existing other valvular disease, coronary artery disease or aortic disease required intervention Note: interventions for arrhythmia or root enlargement are not considered exclusionary.
- Heart Team assessment that chest abnormalities or significant frailty would prevent safe SAVR.
- Native aortic annulus size unsuitable for sizes the currently approved and marketed SAVR or TAVR based on preoperative 3D-CT image analysis.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| surgical aortic valve replacementSAVR | Procedure or surgery | Surgical aortic valve replacement |
| Transcatheter aortic valve replacementTAVR | Procedure or surgery | Transcatheter aortic valve replacement |
Primary outcome
Composite endpoint of all-cause mortality, all stroke, and rehospitalization (valve-related or procedure-related and including heart failure)
Time frame: at 1 year post procedure
14 secondary outcomes
the rate of all-cause mortality or disabling stroke
Time frame: at one year
the rate of all-cause mortality
Time frame: at one year
the rate of all stroke
Time frame: at one year
the rate of disabling stroke
Time frame: at one year
the rate of rehospitalization (valve-related or procedure-related and including heart failure)
Time frame: at one year
the rate of new bundle branch block or new pacemaker implantation
Time frame: at one year
the rate of new onset of atrial fibrillation
Time frame: at 30 days
the rate of life-threatening bleeding
Time frame: at one year
the rate of occurrence of perivalvular regurgitation ≥ mild by echocardiography
Time frame: at one year
Quality of life as assessed by KCCQ
Time frame: at one year
Quality of life as assessed by EQ-5D-5L
Time frame: at one year
the rate of prosthetic valve endocarditis
Time frame: at one year
the rate of prosthetic valve thrombosis
Time frame: at one year
the rate of valve-related dysfunction requiring repeat procedure
Time frame: at one year
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Shigeru Miyagawa, M.D. contact
37 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing surgical aortic valve replacement and Transcatheter aortic valve replacement in people with Aortic Stenosis, run by Osaka University at 37 sites in Japan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 36 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 4 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 37 sites in Japan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Koichi Maeda, M.D. (+81 -6-6879-3154, k-maeda@surg1.med.osaka-u.ac.jp), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Composite endpoint of all-cause mortality, all stroke, and rehospitalization (valve-related or procedure-related and including heart failure) (time frame: at 1 year post procedure). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2026.