title: Sutureless aortic valve replacement: a systematic review and meta-analysis.
abstract: BACKGROUND
  Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature.
  
  
  METHODS
  Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints.
  
  
  RESULTS
  Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable.
  
  
  CONCLUSIONS
  The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Kevin
authors: K
authors: Phan
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Yi-Chin
authors: YC
authors: Tsai
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Nithya
authors: N
authors: Niranjan
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Denis
authors: D
authors: Bouchard
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Thierry P
authors: TP
authors: Carrel
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Otto E
authors: OE
authors: Dapunt
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Harald C
authors: HC
authors: Eichstaedt
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Theodor
authors: T
authors: Fischlein
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Borut
authors: B
authors: Gersak
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Mattia
authors: M
authors: Glauber
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Axel
authors: A
authors: Haverich
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Martin
authors: M
authors: Misfeld
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Peter J
authors: PJ
authors: Oberwalder
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Santarpino
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Malakh Lal
authors: ML
authors: Shrestha
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Marco
authors: M
authors: Solinas
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Marco
authors: M
authors: Vola
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Tristan D
authors: TD
authors: Yan
authors: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
authors: Marco
authors: M
authors: Di Eusanio
keywords: Sutureless; aortic valve replacement (AVR); meta-analysis; minimally invasive