Sutureless Aortic Valve Replacement Superior to Transcatheter Aortic Valve Implantation: A State-of-the-Art Systematic Review, Meta-Analysis

Background: The management of patients with aortic valve pathologies can sometimes fall into a “gray zone,” where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the “gray zone” of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the bioprosthesis over mid-term and long-term follow-up periods.

Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was performed in May 2024.

Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications.

Conclusion: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared with TAVI. SUAVR has more advantages compared with TAVI and can be considered a valuable and promising option for the “grey zone” of aortic valve pathologies.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025