Sutureless aortic versus transcatheter aortic valve implantation for aortic valve disease: A systematic review and meta-analysis of propensity-matched studies_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Yang ¹ , WEI Zhili ¹ , BAI Qiyuan ¹ , LI Xuhua ¹ , LIU Shidong ² , HE Yuyuan ² , HU Yuan ² ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding author：

SONG Bing, Email: songbinldyy@163.com

Keywords：

Surgical aortic valve replacement; transcatheter aortic valve implantation; sutureless aortic valve replacement; propensity score matching; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202409086

Video：

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Objective To evaluate the clinical outcomes of sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) for aortic valve disease. Methods We conducted a computer-based search of databases including CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase and Web of Science from the inception of the databases to March 2024. Two reviewers independently screened articles, extracted data and used the Cochrane bias risk assessment tool to evaluate the quality of the included studies. Meta-analysis was performed using Stata 18 software. Results The included 17 studies using propensity-matched analysis consisted of 6 630 patients, including 3 319 patients in the SU-AVR group and 3 311 patients in the TAVI group. The SU-AVR group had lower mortality than the TAVI group at 1-year ［RR=0.58, 95%CI(0.38, 0.87), P=0.009］, 2-year ［RR=0.61, 95%CI(0.43,0.85), P=0.004］ and 5-year ［RR=0.63, 95%CI(0.50,0.79), P=0.000］. The SU-AVR group had a significantly lower rate of new permanent pacemaker implantation (PPI) ［RR=0.75, 95%CI(0.58, 0.98), P=0.037］, moderate-to-severe paravalvular leak (PVL) ［RR=0.20, 95%CI（0.12, 0.32）, P=0.000］, myocardial infarction(MI)［RR=0.30, 95%CI (0.11,0.80), P=0.017］, more-than-mild residual aortic regurgitation (AR)［RR=0.29, 95%CI（0.17, 0.48）, P=0.000］. In addition, the SU-AVR group had a higher postoperative mean aortic gradient [SMD=0.39, 95%CI (0.17, 0.62), P=0.000］than the TAVI group. Conclusion The early and mid-term clinical outcomes of SU-AVR were superior compared to TAVI.

1.	Seung Hyun L, Nayoung K, Minkyu K, et al. Single-cell transcriptomics reveal cellular diversity of aortic valve and the immunomodulation by PPARγ during hyperlipidemia. Nature Comm, 2022, 13(1): 5461-5461.
2.	Huang N, Zhuang Z, Liu Z, et al. Observational and genetic associations of modifiable risk factors with aortic valve stenosis: A prospective cohort study of 0. 5 million participants. Nutrients, 2022, 14(11): 2273.
3.	Weicong Z , Yake L , Yujiang L , et al. Economic Evaluation of transcatheter aortic valve replacement compared to surgical aortic valve replacement in Chinese intermediate-risk patients. Front Cardiovasc Med, 2022, 9: 896062-896062.
4.	Borbála V, Ilona AN, Astrid A, et al. The predictive value of left atrial strain following transcatheter aortic valve implantation on anatomical and functional reverse remodeling in a multi-modality study. Front Cardiovasc Med, 2022, 9: 841658-841658.
5.	Einarsen E, Hjertaas J J, Gu H, et al. Impact of arterio-ventricular interaction on first-phase ejection fraction in aortic stenosis. Eur Heart J Cardiovasc Imaging, 2021, 22(6): 650-657.
6.	Borbála V , Ilona A N , Astrid A , et al. The predictive value of left atrial strain following transcatheter aortic valve implantation on anatomical and functional reverse remodeling in a multi-modality study. Frontiers in Cardiovascular Medicine, 2022, 9 841658-841658.
7.	Khanji M Y, Ricci F, Galusko V, et al. Management of aortic stenosis: A systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes, 2021, 7(4): 340-353.
8.	Bergmark BA, O'donoghue ML, Murphy SA, et al. An exploratory analysis of proprotein convertase subtilisin/kexin type 9 inhibition and aortic stenosis in the FOURIER trial. JAMA Cardiol, 2020, 5(6): 709-713.
9.	Wu J, Li C, Zheng Y, et al. Temporal trends and outcomes of percutaneous and surgical aortic valve replacement in patients with atrial fibrillation. Front Cardiovasc Med, 2020, 7: 603834-603834.
10.	Fukuhara S, Brescia A A, Shiomi S, et al. Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications. J Thorac Cardiovasc Surg, 2021, 162(2): 539-547. e531.
11.	Di Eusanio M, Berretta P. The sutureless and rapid-deployment aortic valve replacement international registry: Lessons learned from more than 4, 500 patients. Ann Cardiothorac Surg, 2020, 9(4): 289-297.
12.	杨鹏, 谢毅, 王晨昊, 等. Perceval免缝合主动脉瓣在胸骨上段/右侧肋间微创小切口主动脉瓣置换术中的应用. 中国胸心血管外科临床杂志, 2024, 31(3): 439-445.Yang P, Xie Y, Wang CC, et al. Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(3): 439-445.
13.	Theodor F, Thierry F, Bart M, et al. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg, 2020, 161(3): 920-932.
14.	Lin C Y, Lee H A, Lin P J, et al. Sutureless aortic bioprosthesis replacement in elderly Asian patients with aortic stenosis: Experience in a single institution. Biomed J, 2018, 41(4): 265-272.
15.	Wei Y, Huang L, Zhang L, et al. The Newcastle-Ottawa scale score of included studies. Plos One, 2017.
16.	Adrien P, Stéphan R. Newcastle-Ottawa Scale: French translation of the methodological quality scale for cohort studies. Kinésithérapie, la Revue, 2021.
17.	D'onofrio A, Messina A, Lorusso R, et al. Sutureless aortic valve replacement as an alternative treatment for patients belonging to the "gray zone" between transcatheter aortic valve implantation and conventional surgery: A propensity-matched, multicenter analysis. J Thorac Cardiovasc Surg, 2012, 144(5): 1010-1016.
18.	Santarpino G, Pfeiffer S, Jessl J, et al. Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: A propensity-matched analysis of 2 strategies in high-risk patients. J Thorac Cardiovasc Surg, 2014, 147(2): 561-567.
19.	Kamperidis V, Van Rosendael PJ, De Weger A, et al. Surgical sutureless and transcatheter aortic valves: hemodynamic performance and clinical outcomes in propensity score-matched high-risk populations with severe aortic stenosis. JACC Cardiovasc Interv, 2015, 8(5): 670-677.
20.	Muneretto C, Alfieri O, Cesana BM, et al. A comparison of conventional surgery, transcatheter aortic valve replacement, and sutureless valves in "real-world" patients with aortic stenosis and intermediate- to high-risk profile. J Thorac Cardiovasc Surg, 2015, 150(6): 1570-1579.
21.	Santarpino G, Pfeiffer S, Jessl J, et al. Clinical outcome and cost analysis of sutureless versus transcatheter aortic valve implantation with propensity score matching analysis. Am J Cardiol, 2015, 116(11): 1737-1743.
22.	Biancari F, Barbanti M, Santarpino G, et al. Immediate outcome after sutureless versus transcatheter aortic valve replacement. Heart Vessels, 2016, 31(3): 427-433.
23.	D'onofrio A, Salizzoni S, Rubino AS, et al. The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation. J Thorac Cardiovasc Surg, 2016, 152(1): 99-109. e102.
24.	Miceli A, Gilmanov D, Murzi M, et al. Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg, 2016, 49(3): 960-965.
25.	Bruno P, Di Cesare A, Nesta M, et al. Rapid-deployment or transcatheter aortic valves in intermediate-risk patients?. Asian Cardiovasc Thorac Ann, 2017, 25(4): 264-270.
26.	Abdel-Wahab M, Fujita B, Frerker C, et al. Transcatheter versus rapid-deployment aortic valve replacement: A propensity-matched analysis from the german aortic valve registry. JACC Cardiovasc Interv, 2020, 13(22): 2642-2654.
27.	Al-Maisary S, Farag M, Te Gussinklo W H, et al. Are sutureless and rapid-deployment aortic valves a serious alternative to TA-TAVI? A matched-pairs analysis. J Clin Med, 2021, 10(14): 3072.
28.	Chung YH, Lee SH, Ko YG, et al. Transcatheter aortic valve replacement versus sutureless aortic valve replacement: A single center retrospective cohort study. Yonsei Med J, 2021, 62(10): 885-894.
29.	Gerfer S, Mauri V, Kuhn E, et al. Comparison of self-expanding RDV Perceval S versus TAVI ACURATE neo/TF. Thorac Cardiovasc Surg, 2021, 69(5): 420-427.
30.	Vilalta V, Alperi A, Cediel G, et al. Midterm Outcomes following sutureless and transcatheter aortic valve replacement in low-risk patients with aortic stenosis. Circ Cardiovasc Interv, 2021, 14(11): e011120.
31.	Muneretto C, Solinas M, Folliguet T, et al. Sutureless versus transcatheter aortic valves in elderly patients with aortic stenosis at intermediate risk: A multi-institutional study. J Thorac Cardiovasc Surg, 2022, 163(3): 925-935. e925.
32.	Santarpino G, Lorusso R, Moscarelli M, et al. Sutureless versus transcatheter aortic valve replacement: A multicenter analysis of "real-world" data. J Cardiol, 2022, 79(1): 121-126.
33.	Indelen C, Bas T, Kar A, et al. Cost-effectiveness and clinical outcome of transcatheter versus sutureless aortic valve replacement. Heart Surg Forum, 2023, 26(3): E284-e291.
34.	Guner Y, Çiçek A, Karacalilar M, et al. Comparison of postoperative outcomes of sutureless versus stented bioprosthetic aortic valve replacement. Braz J Cardiovasc Surg, 2022, 37(3): 328-334.
35.	Sakata T, De La Pena C, Ohira S. Rapid-deployment aortic valve replacement: Patient selection and special considerations. Vasc Health Risk Manag, 2023, 19: 169-180.
36.	Dhanekula AS, Nishath T, Aldea GS, et al. Use of a sutureless aortic valve in reoperative aortic valve replacement. JTCVS Tech, 2022, 13: 31-39.
37.	Zubarevich A, Rad AA, Szczechowicz M, et al. Sutureless aortic valve replacement in high-risk patients with active infective endocarditis. J Thorac Dis, 2022, 14(9): 3178-3186.
38.	D'onofrio A, Salizzoni S, Filippini C, et al. Surgical aortic valve replacement with new-generation bioprostheses: Sutureless versus rapid-deployment. J Thorac Cardiovasc Surg, 2020, 159(2): 432-442. e431.
39.	Di Eusanio M, Phan K. Sutureless aortic valve replacement. Ann Cardiothorac Surg, 2015, 4(2): 123-130.

1. Seung Hyun L, Nayoung K, Minkyu K, et al. Single-cell transcriptomics reveal cellular diversity of aortic valve and the immunomodulation by PPARγ during hyperlipidemia. Nature Comm, 2022, 13(1): 5461-5461.
2. Huang N, Zhuang Z, Liu Z, et al. Observational and genetic associations of modifiable risk factors with aortic valve stenosis: A prospective cohort study of 0. 5 million participants. Nutrients, 2022, 14(11): 2273.
3. Weicong Z , Yake L , Yujiang L , et al. Economic Evaluation of transcatheter aortic valve replacement compared to surgical aortic valve replacement in Chinese intermediate-risk patients. Front Cardiovasc Med, 2022, 9: 896062-896062.
4. Borbála V, Ilona AN, Astrid A, et al. The predictive value of left atrial strain following transcatheter aortic valve implantation on anatomical and functional reverse remodeling in a multi-modality study. Front Cardiovasc Med, 2022, 9: 841658-841658.
5. Einarsen E, Hjertaas J J, Gu H, et al. Impact of arterio-ventricular interaction on first-phase ejection fraction in aortic stenosis. Eur Heart J Cardiovasc Imaging, 2021, 22(6): 650-657.
6. Borbála V , Ilona A N , Astrid A , et al. The predictive value of left atrial strain following transcatheter aortic valve implantation on anatomical and functional reverse remodeling in a multi-modality study. Frontiers in Cardiovascular Medicine, 2022, 9 841658-841658.
7. Khanji M Y, Ricci F, Galusko V, et al. Management of aortic stenosis: A systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes, 2021, 7(4): 340-353.
8. Bergmark BA, O'donoghue ML, Murphy SA, et al. An exploratory analysis of proprotein convertase subtilisin/kexin type 9 inhibition and aortic stenosis in the FOURIER trial. JAMA Cardiol, 2020, 5(6): 709-713.
9. Wu J, Li C, Zheng Y, et al. Temporal trends and outcomes of percutaneous and surgical aortic valve replacement in patients with atrial fibrillation. Front Cardiovasc Med, 2020, 7: 603834-603834.
10. Fukuhara S, Brescia A A, Shiomi S, et al. Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications. J Thorac Cardiovasc Surg, 2021, 162(2): 539-547. e531.
11. Di Eusanio M, Berretta P. The sutureless and rapid-deployment aortic valve replacement international registry: Lessons learned from more than 4, 500 patients. Ann Cardiothorac Surg, 2020, 9(4): 289-297.
12. 杨鹏, 谢毅, 王晨昊, 等. Perceval免缝合主动脉瓣在胸骨上段/右侧肋间微创小切口主动脉瓣置换术中的应用. 中国胸心血管外科临床杂志, 2024, 31(3): 439-445.Yang P, Xie Y, Wang CC, et al. Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(3): 439-445.
13. Theodor F, Thierry F, Bart M, et al. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg, 2020, 161(3): 920-932.
14. Lin C Y, Lee H A, Lin P J, et al. Sutureless aortic bioprosthesis replacement in elderly Asian patients with aortic stenosis: Experience in a single institution. Biomed J, 2018, 41(4): 265-272.
15. Wei Y, Huang L, Zhang L, et al. The Newcastle-Ottawa scale score of included studies. Plos One, 2017.
16. Adrien P, Stéphan R. Newcastle-Ottawa Scale: French translation of the methodological quality scale for cohort studies. Kinésithérapie, la Revue, 2021.
17. D'onofrio A, Messina A, Lorusso R, et al. Sutureless aortic valve replacement as an alternative treatment for patients belonging to the "gray zone" between transcatheter aortic valve implantation and conventional surgery: A propensity-matched, multicenter analysis. J Thorac Cardiovasc Surg, 2012, 144(5): 1010-1016.
18. Santarpino G, Pfeiffer S, Jessl J, et al. Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: A propensity-matched analysis of 2 strategies in high-risk patients. J Thorac Cardiovasc Surg, 2014, 147(2): 561-567.
19. Kamperidis V, Van Rosendael PJ, De Weger A, et al. Surgical sutureless and transcatheter aortic valves: hemodynamic performance and clinical outcomes in propensity score-matched high-risk populations with severe aortic stenosis. JACC Cardiovasc Interv, 2015, 8(5): 670-677.
20. Muneretto C, Alfieri O, Cesana BM, et al. A comparison of conventional surgery, transcatheter aortic valve replacement, and sutureless valves in "real-world" patients with aortic stenosis and intermediate- to high-risk profile. J Thorac Cardiovasc Surg, 2015, 150(6): 1570-1579.
21. Santarpino G, Pfeiffer S, Jessl J, et al. Clinical outcome and cost analysis of sutureless versus transcatheter aortic valve implantation with propensity score matching analysis. Am J Cardiol, 2015, 116(11): 1737-1743.
22. Biancari F, Barbanti M, Santarpino G, et al. Immediate outcome after sutureless versus transcatheter aortic valve replacement. Heart Vessels, 2016, 31(3): 427-433.
23. D'onofrio A, Salizzoni S, Rubino AS, et al. The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation. J Thorac Cardiovasc Surg, 2016, 152(1): 99-109. e102.
24. Miceli A, Gilmanov D, Murzi M, et al. Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg, 2016, 49(3): 960-965.
25. Bruno P, Di Cesare A, Nesta M, et al. Rapid-deployment or transcatheter aortic valves in intermediate-risk patients?. Asian Cardiovasc Thorac Ann, 2017, 25(4): 264-270.
26. Abdel-Wahab M, Fujita B, Frerker C, et al. Transcatheter versus rapid-deployment aortic valve replacement: A propensity-matched analysis from the german aortic valve registry. JACC Cardiovasc Interv, 2020, 13(22): 2642-2654.
27. Al-Maisary S, Farag M, Te Gussinklo W H, et al. Are sutureless and rapid-deployment aortic valves a serious alternative to TA-TAVI? A matched-pairs analysis. J Clin Med, 2021, 10(14): 3072.
28. Chung YH, Lee SH, Ko YG, et al. Transcatheter aortic valve replacement versus sutureless aortic valve replacement: A single center retrospective cohort study. Yonsei Med J, 2021, 62(10): 885-894.
29. Gerfer S, Mauri V, Kuhn E, et al. Comparison of self-expanding RDV Perceval S versus TAVI ACURATE neo/TF. Thorac Cardiovasc Surg, 2021, 69(5): 420-427.
30. Vilalta V, Alperi A, Cediel G, et al. Midterm Outcomes following sutureless and transcatheter aortic valve replacement in low-risk patients with aortic stenosis. Circ Cardiovasc Interv, 2021, 14(11): e011120.
31. Muneretto C, Solinas M, Folliguet T, et al. Sutureless versus transcatheter aortic valves in elderly patients with aortic stenosis at intermediate risk: A multi-institutional study. J Thorac Cardiovasc Surg, 2022, 163(3): 925-935. e925.
32. Santarpino G, Lorusso R, Moscarelli M, et al. Sutureless versus transcatheter aortic valve replacement: A multicenter analysis of "real-world" data. J Cardiol, 2022, 79(1): 121-126.
33. Indelen C, Bas T, Kar A, et al. Cost-effectiveness and clinical outcome of transcatheter versus sutureless aortic valve replacement. Heart Surg Forum, 2023, 26(3): E284-e291.
34. Guner Y, Çiçek A, Karacalilar M, et al. Comparison of postoperative outcomes of sutureless versus stented bioprosthetic aortic valve replacement. Braz J Cardiovasc Surg, 2022, 37(3): 328-334.
35. Sakata T, De La Pena C, Ohira S. Rapid-deployment aortic valve replacement: Patient selection and special considerations. Vasc Health Risk Manag, 2023, 19: 169-180.
36. Dhanekula AS, Nishath T, Aldea GS, et al. Use of a sutureless aortic valve in reoperative aortic valve replacement. JTCVS Tech, 2022, 13: 31-39.
37. Zubarevich A, Rad AA, Szczechowicz M, et al. Sutureless aortic valve replacement in high-risk patients with active infective endocarditis. J Thorac Dis, 2022, 14(9): 3178-3186.
38. D'onofrio A, Salizzoni S, Filippini C, et al. Surgical aortic valve replacement with new-generation bioprostheses: Sutureless versus rapid-deployment. J Thorac Cardiovasc Surg, 2020, 159(2): 432-442. e431.
39. Di Eusanio M, Phan K. Sutureless aortic valve replacement. Ann Cardiothorac Surg, 2015, 4(2): 123-130.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesSutureless aortic versus transcatheter aortic valve implantation for aortic valve disease: A systematic review and meta-analysis of propensity-matched studies

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