title: Sutureless aortic valve replacement as an alternative treatment for patients belonging to the "gray zone" between transcatheter aortic valve implantation and conventional surgery: a propensity-matched, multicenter analysis.
abstract: OBJECTIVE
  The aim of this propensity-matched, multicenter study was to compare early clinical and echocardiographic outcomes of patients undergoing transapical aortic valve implantation (TA-TAVI) versus patients undergoing sutureless aortic valve replacement (SU-AVR) for severe symptomatic aortic valve stenosis.
  
  
  METHODS
  We reviewed 468 TA-TAVIs performed in 20 centers from April 2008 to May 2011, and 51 SU-AVRs performed in 3 centers from March to September 2011. Based on a propensity score analysis, 2 groups with 38 matched pairs were created. Variables used in the propensity analysis were age, sex, body surface area, New York Heart Association class, logistic EuroSCORE, peripheral vascular disease, chronic obstructive pulmonary disease, aortic valve area, mitral regurgitation, and left ventricular ejection fraction.
  
  
  RESULTS
  Preoperative characteristics of the 2 groups were comparable. Hospital mortality was 5.3% and 0% in the TA-TAVI and SU-AVR groups, respectively (P = .49). We did not observe stroke or acute myocardial infarction in the 2 groups. Permanent pacemaker implantation was needed in 2 patients of each group (5.3%, P = 1.0). Dialysis was required in 2 patients (5.3%) in the SU-AVR group and in 1 patient (2.7%) in the TA-TAVI group (P = 1.0). Predischarge echocardiographic data showed that the incidence of paravalvular leak (at least mild) was greater in the TA-TAVI group (44.7% vs 15.8%, P = .001), but there were no differences in terms of mean transprosthetic gradient (10.3 ± 5 mm Hg vs 11 ± 3.7 mm Hg, P = .59).
  
  
  CONCLUSIONS
  This preliminary experience showed that, in patients at high risk for conventional surgery, SU-AVR is as safe and effective as TA-TAVI and that it is associated with a lower rate of postprocedural paravalvular leak.
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy. adonofrio@hotmail.it
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Ottavio R
authors.initials: OR
authors.lastname: Alfieri
authors.forename: Melissa
authors.initials: M
authors.lastname: Fusari
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubino
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography