Sutureless aortic valve replacement: an alternative to transcatheter aortic valve implantation?

The sutureless aortic bioprosthesis has been recently introduced in clinical practice for aortic valve replacement (SU-AVR) and appears to provide enhanced implantability and favourable haemodynamics, particularly advisable in minimally invasive surgery, in difficult anatomical situations or elderly patients. Implants of sutureless bioprosthesis are increasingly performed, and the first meaningful findings have been released and herewith analysed.

A two-centre experience in 208 patients has shown safety, ease of implantation, excellent haemodynamic performance and limited aortic cross-clamp (ACC) and cardiopulmonary (cardiopulmonary bypass, CPB) times, also in the case of associated coronary artery bypass grafting. Another multicentre experience with a third sutureless, albeit stented, valve implanted in 146 patients has been also presented with early favourable results. The sutureless aortic valve has been reported to be competitive also in relation to the transcatheter aortic valve implantation (TAVI) procedure in high-risk patients, as demonstrated by a propensity score based comparative analysis in a multicentre study, with reduced paravalvular leak rate but with increased atrial fibrillation occurrence in SU-AVR cases. Other single-centre series have been published with satisfactory results in terms of excellent haemodynamic performances or of enhanced implantability in high-risk patients or during minimally invasive procedures.

Sutureless aortic valve replacement has been shown to be well tolerated, to provide excellent haemodynamic performance and to be particularly suitable in minimally invasive procedures or in patients with extensive calcified aortic root or with the need of short ACC and CPB times for marked comorbidities. Further evaluations are, however, still necessary to conclusively show the actual advantages of SU-AVR, also as an alternative to TAVI procedures in operable high-risk patients.