title: Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies.
abstract: BACKGROUND
  With improving technologies and an increasingly elderly populations, there have been an increasing number of therapeutic options available for patients requiring aortic valve replacement. Recent evidence suggests that transcatheter aortic valve implantation (TAVI) is one suitable option for high risk inoperable patients, as well as high risk operable patients. Sutureless valve technology has also been developed concurrently, with facilitates surgical aortic valve replacement (SUAVR) by allow resection and replacement of the native aortic valve with minimal sutures and prosthesis anchoring required. For patients amenable for both TAVI and SUAVR, the evidence is unclear with regards to the benefits and risks of either approach. The objectives are to compare the perioperative outcomes and intermediate-term survival rates of TAVI and SUAVR in matched or propensity score matched studies.
  
  
  METHODS
  A systematic literature search was performed to include all matched or propensity score matched studies comparing SUAVR versus TAVI for severe aortic stenosis. A meta-analysis with odds ratios (OR) and mean differences were performed to compare key outcomes including paravalvular regurgitation and short and intermediate term mortality.
  
  
  RESULTS
  Six studies met our inclusion criteria giving a total of 741 patients in both the SUAVR and TAVI arm of the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in perioperative mortality, however SUAVR patients had significantly better survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR =4.62; 95% CI: 2.62-8.12, P<0.01).
  
  
  CONCLUSIONS
  The present study supports the use of minimally invasive SUAVR as an alternative to TAVI in high risk patients requiring aortic replacement. The presented results require further validation in prospective, randomized controlled studies.
authors.affiliation: Department of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wang
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Yi-Chin
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Niles
authors.affiliation: Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Vakhtang
authors.initials: V
authors.lastname: Tchantchaleishvili
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini' Hospital Piazza Italia, Teramo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.affiliation: Department of Medicine, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
keywords: Transcatheter aortic valve replacement; aortic stenosis; meta-analysis; sutureless aortic valve replacement