title: Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies.
abstract: To determine which improves clinical outcomes more, sutureless (including rapid-deployment) aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of comparative studies.
  
  
  
  MEDLINE and EMBASE were searched through June 2015 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a comparative study; the study population included patients with severe aortic valve stenosis, patients were assigned to sutureless AVR versus TAVI; and main outcomes included at least early (in-hospital or 30-day) all-cause mortality.
  
  
  
  Of 87 potentially relevant articles screened initially, no randomized controlled trials and 7 observational comparative studies of sutureless AVR versus TAVI (enrolling a total of 945 patients) were identified and included. The first pooled analysis demonstrated a statistically significant reduction in mortality with sutureless AVR over TAVI [2.5% versus 7.3%; odds ratio (OR), 0.33; 95% confidence interval (CI), 0.16 to 0.69; p=0.003; risk difference (RD), -5.23%; 95% CI, -8.12% to -2.33%; p=0.0004]. The second pooled analyses demonstrated no statistically significant difference in bleeding complications, acute kidney injury, and conduction disturbance between sutureless AVR and TAVI. The third pooled analysis demonstrated a statistically significant reduction in paravalvular aortic regurgitation (AR) with sutureless AVR over TAVI (3.5% versus 33.2%; OR, 0.09; 95% CI, 0.05 to 0.16, p<0.00001; MD, -22.56%; 95% CI, -36.59% to -8.53%; p=0.002).
  
  
  
  Compared with TAVI, sutureless AVR may be associated with a reduction in early mortality and postoperative paravalvular AR.
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. Electronic address: kfgth973@ybb.ne.jp.
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Umemoto
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D000071062:Sutureless Surgical Procedures / Q000379:methods / Q000401:mortality*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality*
keywords: Meta-analysis; Sutureless aortic valve replacement; Transcatheter aortic valve replacement