TAVR vs Sutureless Surgical Aortic Valve Replacement in Low-Risk Patients

Sutureless surgical aortic valve replacement (SU-SAVR) has been designed to make surgical valve replacement easier and faster, especially compared against conventional biological valves which require multiple sutures; their rapid deployment translates into reduced cross-clamp and operative time.

TAVI vs válvulas quirúrgicas de “liberación rápida” en pacientes de bajo riesgo

These valves shorten operating time and are less invasive than conventional surgical valves. 

Except for sternotomy incisions, they share several features with TAVR valves (for instance, the fact that they are balloon-expandable), but they offer surgeons the advantage of a full view: with no need of complex CT scans and projections for sizing, surgeons can fully appreciate the annulus for implantation, which makes it easier for them to sort out an obstruction, if there were any. 

These valves share with TAVR valves the risk of pacemaker need. 

So far, the data we had on these valves were from high surgical risk patients. This novel study tested both valves in low-risk patients. 

It included 806 consecutive low risk patients (EuroSCORE II <4%) receiving TAVR or SU-SAVR. After propensity score matching, 171 pairs with similar baseline characteristics were identified.  Mean EuroSCORE II was 1.9% in both groups. 

There were no significant differences in in-hospital mortality (SU-SAVR 4.1%, TAVR: 1.8%, P=0.199) or stroke (2.3% vs 2.9%; p=0.736).


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Sutureless valves showed significantly higher bleeding (p<0.001), atrial fibrillation (p<0.001), and transvalvular gradient (p<0.001) and lower rate of pacemaker implantation (p=0.01).

After a mean 2-year followup, there were no differences in death or stroke rates. SU-SAVR was associated with more hospitalizations for cardiac failure (p=0.002).

Conclusion

In patients with low-risk aortic stenosis, TAVR showed better in-hospital results (except for pacemaker implantation rate) compared against Sutureless valves. 

Both procedures showed similar mortality and stroke rates at 2 years with a few more hospitalizations for cardiac failures in the Sutureless valve arm. 

These outcomes only reinforce what was already well known about the low-risk population. 

Original Title: Midterm Outcomes Following Sutureless and Transcatheter Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis.

Reference: Victoria Vilalta et al. Circ Cardiovasc Interv. 2021 Oct 5;CIRCINTERVENTIONS121011120. Online ahead of print. doi: 10.1161/CIRCINTERVENTIONS.121.011120. 


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