title: Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients.
abstract: OBJECTIVE
  The aim of this study was to compare early outcomes and mid-term survival of high-risk patients undergoing minimally invasive aortic valve replacement through right anterior mini-thoracotomy (RT) with sutureless valves versus patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis.
  
  
  METHODS
  From October 2008 to March 2013, 269 patients with severe aortic stenosis underwent either RT with perceval S sutureless valves (n = 178 patients, 66.2%) or TAVI (n = 91, 33.8%: 44 transapical and 47 trans-femoral). Of these, 37 patients undergoing RT with the perceval S valve were matched to a TAVI group by the propensity score.
  
  
  RESULTS
  Baseline characteristics were similar in both groups (mean age 79 ± 6 years) and the median logistic EuroSCORE was 14% (range 9-20%). In the matched group, the in-hospital mortality rate was 8.1% (n = 3) in the TAVI group and 0% in the RT group (P = 0.25). The incidence rate of stroke was 5.4% (n = 2) versus 0% in the TAVI and RT groups (P = 0.3). In the TAVI group, 37.8% (n = 14) had mild paravalvular leakage (PVL) and 27% (n = 10) had moderate PVL, whereas 2.7% (n = 1) had mild PVL in the RT group (P < 0.001). One- and 2-year survival rates were 91.6 vs 78.6% and 91.6 vs 66.2% in patients undergoing RT with the perceval S sutureless valve compared with those undergoing TAVI, respectively (P = 0.1).
  
  
  CONCLUSIONS
  Minimally invasive aortic valve replacement with perceval S sutureless valves through an RT is associated with a trend of better early outcomes and mid-term survival compared with TAVI.
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy antoniomiceli79@alice.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Daniyar
authors.initials: D
authors.lastname: Gilmanov
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Marchi
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferrarini
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Alfredo G
authors.initials: AG
authors.lastname: Cerillo
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Quaini
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*
keywords: Aortic valve replacement; Heart valve replacement; Percutaneous; Transapical