title: The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR.
  
  
  METHODS
  Data were analyzed on patients who underwent TAVI and patients who underwent SU-AVR. Two matched cohorts (TAVI vs SU-AVR) were created using propensity scores; all analyses were repeated for transapical TAVI and transfemoral TAVI, separately. Outcomes were defined according to Valve Academic Research Consortium-2 criteria.
  
  
  RESULTS
  A total of 2177 patients were included in the analysis: 1885 (86.6%) treated with TAVI; 292 (13.4%) treated with SU-AVR. Mortality in unmatched TAVI and SU-AVR patients was 7.1% and 2.1%, respectively, at 30 days, and 12.9% and 4.6%, respectively, at 1 year. No differences were found in 30-day mortality in the 214 matched patient pairs (3.7% vs 2.3%; P = .4), but patients treated with TAVI showed a lower incidence of device success (85.9% vs 98.6%; P < .001) and pacemaker implantation (2.8% vs 9.4%; P = .005), and a higher incidence of any paravalvular leakage (PVL).
  
  
  CONCLUSIONS
  SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: adonofrio@hotmail.it.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Department of Cardiac Surgery, University of Turin-Città della Salute e della Sceinza-Molinette, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Department of Cardiac Surgery, AOU-Policlinico Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Besola
authors.affiliation: Department of Cardiac Surgery, University of Turin-Città della Salute e della Sceinza-Molinette, Turin, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Filippini
authors.affiliation: Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Cardiac Surgery, University of Milan-Monzino Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.affiliation: Department of Cardiac Surgery, Nürnberg Clinic, Nürnberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Department of Cardiac Surgery, IRCCS San Martino-National Institute for Cancer Research, Genova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rapetto
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Cardiac Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Dalèn
authors.affiliation: Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Meuris
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliera Universitaria S. Orsola, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Marco Luigi
authors.initials: ML
authors.lastname: Aiello
authors.affiliation: Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Cardiac Surgery, AOU S. Maria Misericordia, Udine, Italy.
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.affiliation: Department of Cardiac Surgery, AOU Careggi, Firenze, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Stefàno
authors.affiliation: Department of Cardiac Surgery, S. Maria Hospital, Bari, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.affiliation: Ospedale Maggiore, Parma, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Borrello
authors.affiliation: Department of Cardiac Surgery, AOU-Policlinico Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Department of Cardiac Surgery, University of Turin-Città della Salute e della Sceinza-Molinette, Turin, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mignosa
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement
keywords: aortic valve replacement; heart valve replacement; heart valve replacement sutureless; percutaneous; transapical