title: Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: a propensity-matched analysis of 2 strategies in high-risk patients.
abstract: OBJECTIVE
  This propensity-matched study compared clinical and echocardiographic outcomes between patients undergoing transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement.
  
  
  METHODS
  From January 2010 to March 2012, 122 patients (age 79.4 ± 5.3 years, logistic euroSCORE 12% ± 8.4%) underwent minimally invasive sutureless aortic valve replacement, and 122 (age 84.6 ± 6.2 years, logistic euroSCORE 20.9% ± 2.5%) underwent TAVI. After propensity matching, 37 matched pairs were available for analysis.
  
  
  RESULTS
  Preoperative characteristics and risk scores of matched groups were comparable. In-hospital mortalities were 0% in the sutureless group and 8.1% (n = 3) in the TAVI group (P = .24). Permanent pacemaker implantation was required in 4 patients in the sutureless group and 1 patient in the TAVI group (10.8% vs 2.7%; P = .18). A neurologic event was recorded in 2 patients of each group. Predischarge echocardiographic data showed higher paravalvular leak rate in the TAVI group (13.5% vs 0%; P = .027). At mean follow-up of 18.9 ± 10.1 months, overall cumulative survival was 91.9% and significantly differed between groups (sutureless 97.3% vs TAVI 86.5%; P = .015). In the TAVI group, a significant difference in mortality was observed between patients with (n = 20) and without (n = 17) paravalvular leak (25% vs 0%; P = .036).
  
  
  CONCLUSIONS
  Combining the advantage of standard diseased valve removal with shorter procedural times, minimally invasive sutureless aortic valve replacement may be the first-line treatment for high-risk patients considered in the "gray zone" between TAVI and conventional surgery.
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nürnberg, Germany. Electronic address: g.santarpino@libero.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nürnberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.affiliation: Department of Cardiology, Klinikum Nürnberg, Nürnberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Jessl
authors.affiliation: Department of Cardiac Surgery, Universitätsklinikum Münster, Münster, Germany.
authors.forename: Angelo Maria
authors.initials: AM
authors.lastname: Dell'Aquila
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nürnberg, Germany.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pollari
authors.affiliation: Department of Cardiology, Klinikum Nürnberg, Nürnberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pauschinger
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nürnberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / 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; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome
keywords: 28; 28.1; 35; 35.2; AVR; CABG; CORONARY; Coronary Artery Bypass Surgery Off- or On-Pump Revascularization Study; PARTNER; Placement of AoRTic TraNscathetER Valve [trial]; Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve [trial]; TAVI; TRITON; aortic valve replacement; coronary artery bypass grafting; transcatheter aortic valve implantation