Yonsei Med J.  2021 Oct;62(10):885-894. 10.3349/ymj.2021.62.10.885.

Transcatheter Aortic Valve Replacement versus Sutureless Aortic Valve Replacement: A Single Center Retrospective Cohort Study

• Chung YH
• Lee SH
• Ko YG
• Lee S
• Shim CY
• Ahn CM
• Hong GR
• Shim JK
• Kwak YL
• Hong MK

• KMID: 2520376
• DOI: http://doi.org/10.3349/ymj.2021.62.10.885

Abstract

Purpose
This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR).
Materials and Methods
In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared.
Results
Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960).
Conclusion
TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.

Keyword

Aortic stenosis; transcatheter aortic valve replacement; sutureless aortic valve replacement; severe aortic stenosis