Perceval sutureless versus conventional sutured valves for surgical aortic valve replacement: an updated meta-analysis of 5,828 patients

To compare the clinical performance of Perceval sutureless valves (PAVR) versus conventional sutured aortic valve replacement (CAVR) in adult patients undergoing surgical aortic valve replacement, with a focus on operative times and perioperative complications. The meta-analysis were conducted following the PRISMA guidelines. A systematic search of PubMed, Embase, and the Cochrane Library was conducted through April 2024. Primary outcomes included cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, early mortality, and postoperative complications, such as paravalvular leak (PVL), permanent pacemaker implantation (PPI), and postoperative atrial fibrillation (POAF). Data were pooled using random-effects models, and heterogeneity was assessed with the I 2 statistic. Twenty studies encompassing 5,828 patients were included (2,031 in the PAVR group and 3,787 in the CAVR group). No significant difference was observed in early mortality between the two groups. The PAVR group demonstrated markedly shorter CPB time (mean difference: -21.50 min, 95% CI: -25.64 to -17.36, p < 0.001) and ACC time (mean difference: -21.29 min, 95% CI: -26.56 to -16.01, p < 0.001) compared with the CAVR group. Additionally, PAVR group was associated with higher incidence of paravalvular leak (OR = 2.66; 95% CI:1.56–4.54; p < 0.001) and increased requirement for permanent pacemaker implantation (OR = 1.97; 95% CI:1.36–2.85; p < 0.001). Conversely, a lower incidence of postoperative atrial fibrillation was observed in the PAVR group (OR = 0.54, 95% CI: 0.40–0.73, p < 0.001). Across a broad spectrum of patients undergoing surgical aortic valve replacement, PAVR is associated with significantly reduced operative times and a lower incidence of postoperative atrial fibrillation compared to CAVR. However, these advantages are accompanied by an increased risk of paravalvular leak and permanent pacemaker implantation. Despite similar early mortality between groups, the trade-offs between procedural efficiency and conduction-related complications should be carefully considered. Further high-quality prospective studies are warranted to evaluate long-term outcomes and to optimize patient selection for sutureless valve implantation.