Sutureless and Rapid-Deployment Aortic Valves versus TA-TAVI: A Matched Pairs Analysis

Background: Conventional surgical aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. In intermediate and high-risk patients transcatheter aortic valve implantation (TAVI) is a feasible alternative with expanding indication. Sutureless and rapid-deployment aortic valves (SURD-AVR) were suggested to decrease procedural risks in conventional treatment. This present paired-match analysis aims to compare patients undergoing TAVI or SURD-AVR.

Methods: Retrospective database analysis revealed 214 patients undergoing trans-apical TAVI (TA-TAVI) procedure and 62 SURD-AVR procedures including 26 patients in need of concomitant CABG. After matching for age, gender, BMI, emergency indication, dialysis and additive EuroSCORE, 52 pairs of patients were included and analyzed.

Results: In-hospital death (TAVI: n = 3, 5.8% vs. SU-AVR: n = 1, 1.9% death; p = 0.308) was comparable between TAVI (mean age: 77 ± 4.3 years) and SURD-AVR groups (mean age: 75 ± 4.0 years) including 32 females in each group. Logistic EuroSCORE was similar (TAVI: 19 ± 12 vs. SURD-AVR: 17 ± 10; p = 0.257). Renal failure requiring dialysis (TAVI: n = 4, 7.7% vs. SURD-AVR: n = 1, 1.9%; p = 0.169) and cerebrovascular accidents (TAVI: n = 0 vs. SURD-AVR: n = 1, 1.9%; p = 0.315) were without significant difference. Complete heart block requiring permanent pacemaker was relatively rare in both groups (TAVI: n = 1, 1.9% vs. SURD-AVR: n = 4, 7.7%; p = 0.169). Intraoperative use of blood transfusion was higher in SURD-AVR group (TAVI: 0.72 U vs. SURD-AVR: 1.46 U, p = 0.014). Aortic regurgitation (AR) at discharge was significantly more common after TA-TAVI (TAVI: n = 14, 27% vs. SURD-AVR: n = 3, 5%; p = 0.013); however, relevant AR was detected in only one TAVI and no SURD-AVR patient. Kaplan–Meier estimated survival calculated no significant difference between both groups after 6 months (TAVI: 74 ± 8% vs. SURD-AVR: 92 ± 5%; log rank p = 0.097).

Conclusions: This present study showed that SURD-AVR is as safe and effective as TA-TAVI in patients at intermediate and high-risk for conventional surgery with low early morbidity and mortality. Combining the advantage of standard diseased valve removal with shorter procedural times, sutureless aortic valve replacement may be the first-line treatment for high-risk patients considered in the “gray zone” between TAVI and conventional surgery especially if concomitant myocardial revascularization is required.