Key result
Sutureless aortic valve replacement significantly reduced 1-year mortality (RR 0.53) compared to transcatheter aortic valve implantation in patients with aortic valve stenosis.
Why the study?
The study was conducted to evaluate the clinical outcomes of sutureless aortic valve replacement compared with transcatheter aortic valve implantation.
Does sutureless aortic valve replacement improve mortality and clinical outcomes compared to transcatheter aortic valve implantation in patients undergoing aortic valve replacement?
Meta-Analysis (n=6,516)
Does sutureless aortic valve replacement improve mortality and clinical outcomes compared to transcatheter aortic valve implantation in patients undergoing aortic valve replacement?
Relative Risk: 0.53 (95% CI 0.32–0.87)
p-value: p=0.01
In propensity-matched observational studies, sutureless aortic valve replacement was associated with lower early and mid-term mortality, fewer paravalvular leaks, and fewer pacemaker implantations compared to TAVI, though it carried a higher risk of atrial fibrillation and bleeding.
May support sutureless AVR over TAVI for lower mortality in aortic stenosis; leaves open confirmation in randomized trials.
Background: To evaluate the clinical outcomes of sutureless aortic valve replacement (SUAVR) and transcatheter aortic valve implantation (TAVI). Methods: We systematically searched the electronic database and the Clinical Trials Registry up to 31 February 2023. Random effects model risk ratio (RR) and mean differences (MD) with corresponding 95% confidence intervals (CIs) were pooled for the clinical outcomes. Results: The included 16 studies using propensity-matched analysis consisted of 6516 patients, including 3258 patients in the SUAVR group and 3258 patients in the TAVI group. The SUAVR group had lower mortality than the TAVI group at 1-year [RR = 0.53, 95% CI (0.32, 0.87), I2 = 49%, p = 0.01], 2-year [RR = 0.56, 95% CI (0.37, 0.82), I2 = 51%, p = 0.03] and 5-year [RR = 0.56, 95% CI (0.46, 0.70), I2 = 0%, p < 0.01]. The SUAVR group had a significantly lower rate of new permanent pacemaker implantation (PPI) [RR = 0.74, 95% CI (0.55, 0.99), I2 = 48%, p = 0.04], moderate-to-severe paravalvular leak (PVL) [RR = 0.18, 95% CI (0.11, 0.30), I2 = 0%, p < 0.01], more-than-mild residual aortic regurgitation (AR) [RR = 0.27, 95% CI (0.14, 0.54), I2 = 0%, p < 0.01]. In addition, the SUAVR group had a higher rate of new-onset atrial fibrillation (AF) [RR = 3.66, 95% CI (1.95, 6.89), I2 = 84%, p < 0.01], major or life-threatening bleeding event [RR = 3.63, 95% CI (1.81, 7.28), I2 = 83%, p < 0.01], and higher postoperative mean aortic gradient [MD = 1.91, 95% CI (0.73, 3.10), I2 = 91%, p < 0.01] than the TAVI group. Conclusions: The early and mid-term clinical outcomes of SUAVR were superior compared to TAVI. Further studies should be conducted to highlight the specific subgroups of patients. that will benefit from each technique. INPLASY Registration Number: INPLASY 2022110058 (https://inplasy.com/inplasy-2022-11-0058/).
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Liu et al. (2024) conducted a meta-analysis in Aortic valve stenosis (n=6,516). Sutureless aortic valve replacement (SUAVR) vs. Transcatheter aortic valve implantation (TAVI) was evaluated on 1-year mortality (RR 0.53, 95% CI 0.32-0.87, p=0.01). Sutureless aortic valve replacement significantly reduced 1-year mortality (RR 0.53) compared to transcatheter aortic valve implantation in patients with aortic valve stenosis.
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