Are Sutureless and Rapid-Deployment Aortic Valves a Serious Alternative to TA-TAVI? A Matched-Pairs Analysis

Abstract

Background: Transcatheter aortic valve implantation is a feasible alternative to conventional aortic valve replacement with expanding indication extending to low-risk patients. Sutureless and rapid-deployment aortic valves were developed to decrease procedural risks in conventional treatment. This paired-match analysis aims to compare patients undergoing surgical transcatheter aortic valve implantation to sutureless and rapid-deployment aortic valve implantation. Methods: Retrospective database analysis between 2010 and 2016 revealed 214 patients undergoing transcatheter aortic valve implantation procedures through surgical access (predominantly transapical) and 62 sutureless and rapid-deployment aortic valve procedures including 26 patients in need of concomitant coronary artery bypass surgery. After matching, 52 pairs of patients were included and analyzed. Results: In-hospital death (5.8% vs. 3.8%; p = 0.308) was comparable between transcatheter aortic valve implantation (mean age 77 ± 4.3 years) and sutureless and rapid-deployment aortic valve implantation groups (mean age 75 ± 4.0 years), including 32 females in each group. The logistic EuroSCORE was similar (19 ± 12 vs. 17 ± 10; p = 0.257). Postoperative renal failure (p = 0.087) and cerebrovascular accidents (p = 0.315) were without significant difference. The incidence of complete heart block requiring permanent pacemaker treatment was relatively low for both groups (1.9% vs. 7.7%; p = 0.169) for TAVI and sutureless and rapid-deployment valves respectively. Intraoperative use of blood transfusion was higher in the sutureless and rapid-deployment aortic valve implantation group (0.72 U vs. 1.46 U, p = 0.014). Estimated survival calculated no significant difference between both groups after 6 months (transcatheter aortic valve implantation: 74 ± 8% vs. sutureless and rapid-deployment aortic valve implantation: 92 ± 5%; log rank p = 0.097). Conclusion: Since sutureless and rapid-deployment aortic valve implantation is as safe and effective as transapical transcatheter aortic valve implantation, combining the advantage of standard diseased-valve removal with shorter procedural times, sutureless and rapid-deployment aortic valve replacement may be considered as an alternative for patients with elevated operative risk considered to be in the “gray zone” between transcatheter aortic valve implantation and conventional surgery, especially if concomitant myocardial revascularization is required.

Early and late outcomes of surgical aortic valve replacement with sutureless and rapid‐deployment valves versus transcatheter aortic valve implantation: Meta‐analysis with reconstructed time‐to‐event data of matched studies

“…The accompanying survival estimates are presented in Table . The data of 1322 patients (SURD‐AVR: 661 patients; TAVI: 661 patients) from 6 studies 16–19,22,25 with a median follow‐up of 17.6 months (interquartile range: 8.14–33.5 months) were pooled. Patients in the TAVI group had a significantly worse overall survival (hazard ratio: 1.74; 95% CI: 1.26–2.40; p < 0.001).…”

“…After excluding duplicates and noneligible studies, ten studies [16][17][18][19][20][21][22][23][24][25] met our eligibility criteria (Figure 1). All studies were nonrandomized and observational, with two studies being prospective and four studies multicentric (Table 1).…”

Sutureless aortic valve replacement in pure aortic regurgitation: expanding the indications

“…Whilst transcatheter technologies have been very promising in patients presenting with moderate-to severe aortic valve disease, patients with the pure aortic regurgitation, with exception of some small studies on the off-label use, are officially not eligible for this treatment option [ 12 ]. SU-AVR has proven to be a feasible alternative to TAVR in patients with stenotic aortic valve disease, therefore we aimed to review our experience with the implementation of SU-AVR methods in patients with pure aortic valve regurgitation [ 9 , 10 , 13 ]. Given that TAVR procedure is strictly contraindicated in patients with isolated aortic regurgitation, SU-AVR could present the only minimally invasive treatment option for these patients.…”

Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath

“…These patients are considered to be in the “grey-area” between the transfemoral TAVR and conventional SAVR and could benefit from any other alternative to both procedures. Whilst transapical TAVR access is a standard route for TAVR in patients ineligible for transfemoral access, SU-AVR proved to be a feasible alternative for TAVR in patients with intermediate or high surgical risk [ 1 , 18 , 21 , 25 ]. Therefore, hereby we sought to evaluate our results with SU-AVR in intermediate-risk patients and compare them to those of TA-TAVR.…”

“…Moreover, the much simpler implantation technique of sutureless prostheses allows for their broad implementation in minimal invasive aortic valve procedures through a J-sternotomy or right antero-lateral thoracotomy access [ 11 , 12 ]. Due to a considerable number of patients falling into the “grey area” between TAVR and a conventional surgical procedure, several trials have been conducted to compare TAVR with SAVR using rapid deployment or sutureless valve prostheses [ 13 , 14 , 15 , 16 , 17 , 18 ].…”