title: Better short-term outcome by using sutureless valves: a propensity-matched score analysis.
abstract: BACKGROUND
  Sutureless aortic valve prostheses have the potential of shortening ischemic time. However, whether shorter operative times may also result in improved patient outcomes and have an effect on hospital costs remains to be established.
  
  
  METHODS
  From March 2010 to April 2013, 566 patients underwent aortic valve replacement with bioprostheses; of these, 166 received a sutureless valve, and 400 received a stented valve. Redo and associated procedures were included. A propensity-score analysis was used to create two groups (sutureless and stented) with 82 matched pairs with comparable preoperative characteristics. Hospital outcome, follow-up, and health care resource consumption were compared.
  
  
  RESULTS
  There were 3 hospital deaths in the stented group and 2 in the sutureless group (p=0.65). Aortic cross-clamp, cardiopulmonary bypass, and operation times were significantly shorter in the sutureless group (p<0.001). Patients in the sutureless group required blood transfusion less frequently (1.2±1.3 vs 2.5±3.7 units, p=0.005), with a similar need for reexploration for bleeding (2 vs 5, p=0.221). The sutureless group had a shorter intensive care unit stay (2.0±1.2 vs 2.8±1.3 days, p<0.001), hospital stay (10.9±2.7 vs 12.4±4.4 days, p=0.001) and intubation time (9.5±4.6 vs 16.6±6.4 hours, p<0.001), and a lower incidence of postoperative atrial fibrillation (p=0.015), pleura effusions (p=0.024), and respiratory insufficiency (p=0.016). Pacemaker implantation and occurrence of neurologic events were similar between groups (p>0.05). A lower rate of postoperative complications resulted in reduced resource consumption in the sutureless group for diagnostics (€2,153 vs €1,387), operating room (€5,879 vs €5,527), and hospital stay (€9,873 vs €6,584), with a total cost saving of approximately 25% (€17,905 vs €13,498).
  
  
  CONCLUSIONS
  A shorter procedural time in the sutureless group is associated with better clinical outcomes and reduced hospital costs.
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany. Electronic address: fpollari@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pollari
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
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, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Gazdag
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
authors.forename: Husam
authors.initials: H
authors.lastname: Alnahas
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome