title: Conventional surgery, sutureless valves, and transapical aortic valve replacement: what is the best option for patients with aortic valve stenosis? A multicenter, propensity-matched analysis.
abstract: OBJECTIVE
  Although surgical aortic valve replacement (SAVR) is the treatment of choice for patients with aortic valve stenosis, transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR) have shown good results. The aim of our multicenter, propensity-matched study was to compare the clinical and hemodynamic outcomes of surgical SAVR, transapical TAVR (TA-TAVR), and SU-AVR.
  
  
  METHODS
  We analyzed data from 566 TA-TAVR, 349 SAVR, and 38 SU-AVR patients treated from January 2009 to March 2012. We used a propensity-matching strategy to compare on-pump (SAVR, SU-AVR) and off-pump (TA-TAVR) surgical techniques. The outcomes were analyzed using multivariate weighted logistic regression or multinomial logistic analysis.
  
  
  RESULTS
  In the matched cohorts, the 30-day overall mortality was significantly lower after SAVR than TA-TAVR (7% vs 1.8%, P = .026), with no differences in mortality between SU-AVR and TA-TAVR. Multivariate analysis showed SU-AVR to have a protective effect, although not statistically significant, against aortic regurgitation, pacemaker implantation, and renal replacement therapy compared with TA-TAVR. Compared with TA-TAVR, SAVR demonstrated significant protection against aortic regurgitation (odds ratio, 0.04; P < .001) and a trend toward protection against death, pacemaker implantation, and myocardial infarction. The mean transaortic gradient was 10.3 ± 4.4 mm Hg, 11 ± 3.4 mm Hg, and 16.5 ± 5.8 mm Hg in the TA-TAVR, SU-AVR, and SAVR patients, respectively.
  
  
  CONCLUSIONS
  SAVR was associated with lower 30-day mortality than TA-TAVR. SAVR was also associated with a lower risk of postoperative aortic regurgitation compared with TA-TAVR. We did not find other significant differences in outcomes among matched patients treated with SAVR, SU-AVR, and TA-TAVR.
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: adonofrio@hotmail.it.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Giulio
authors.initials: G
authors.lastname: Rizzoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Laura
authors.initials: L
authors.lastname: Besola
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
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 / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D057216:Propensity Score; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome
keywords: 35.2; AR; OHS; PARTNER; Placement of Aortic Transcatheter Valve; SAVR; SSAVS; SU-AVR; TA-TAVR; TAVR; aortic regurgitation; open-heart surgery; severe symptomatic aortic valve stenosis; surgical aortic valve replacement; sutureless aortic valve replacement; transapical transcatheter aortic valve replacement; transcatheter aortic valve replacement