Immediate outcome after sutureless versus transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Aortic valve replacement is a critical procedure for severe aortic stenosis.
• Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SU-AVR) are primary treatment options.
• The Perceval bioprosthesis offers a sutureless option for SU-AVR, potentially simplifying the procedure.

Purpose of the Study:

• To compare the immediate outcomes of TAVI versus SU-AVR using the Perceval bioprosthesis.
• To evaluate in-hospital mortality, paravalvular regurgitation, and pacemaker implantation rates.
• To assess the safety and efficacy of SU-AVR with the Perceval prosthesis in intermediate-risk patients.

Main Methods:

• Retrospective multicenter analysis of 773 patients undergoing TAVI or SU-AVR with the Perceval prosthesis.
• Data collected from six European institutions for SU-AVR and one for TAVI.
• Propensity score-matched analysis was performed on 144 pairs to control for baseline characteristics and operative risk.

Main Results:

• In-hospital mortality was not significantly different in the overall cohort (SU-AVR 2.6% vs. TAVI 5.3%, p=0.057).
• TAVI showed significantly higher rates of mild and moderate-severe paravalvular regurgitation (p < 0.0001) and permanent pacemaker implantation (p = 0.003) compared to SU-AVR.
• In propensity-matched pairs, in-hospital mortality was significantly higher after TAVI (6.9% vs. 1.4%, p=0.035).

Conclusions:

• Surgical aortic valve replacement with the sutureless Perceval prosthesis is associated with excellent immediate survival in intermediate-risk patients.
• SU-AVR with the Perceval prosthesis demonstrates a lower incidence of paravalvular regurgitation and need for pacemaker implantation compared to TAVI.
• SU-AVR with the Perceval prosthesis represents a valid and safe alternative to TAVI for intermediate-risk patients undergoing aortic valve replacement.