Sutureless versus transcatheter valves for the treatment of aortic valve stenosis: a systematic review and meta-analysis

Abstract

An important limitation of the pivotal randomized controlled trials that compared transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) is that the SAVR arm scarcely included sutureless bioprosthetic valves. We identified 13 retrospective propensity-matched studies in low (n = 2), intermediate (n = 8), and high-risk (n = 3) patients, using EuroSCORE and STS score to assess perioperative risk. One large registry drove the outcome in low-risk patients, showing better early survival with TAVR, lower rates of stroke and acute kidney injury. Intermediate-risk patients showed improved early and medium-term survival with SU-AVR, whilst in high-risk patients, no significant differences were seen between treatment options. Overall, across all risk categories, the rates of moderate and severe aortic regurgitation and permanent pacemaker implantation were significantly lower with SU-AVR, while transprosthetic gradients and duration of hospital stay were higher compared to TAVR. The differences in survival in the intermediate risk group are not in line with conclusions of pivotal randomized trials comparing TAVR with SAVR. Specific features of SU-AVR may account for these survival differences, positioning SU-AVR as a valid and safe alternative for patients at intermediate risk. Awaiting confirmation in randomized trials, careful patient selection and consideration of either of the AVR options in the heart team remain crucial.