Transcatheter or sutureless/rapid-deployment aortic valve replacement? Contemporary insights from an individual...

Transcatheter aortic valve replacement (TAVR) and sutureless/rapid-deployment aortic valve replacement (SUAVR) have each undergone rapid technological advances and expanding indications. However, direct comparative evidence between the two, particularly for long-term outcomes, remains limited.

We conducted an updated meta-analysis of propensity score-matched studies using reconstructed individual patient data (IPD) to compare TAVR with SUAVR. The protocol was registered in PROSPERO (CRD420251046330). Published Kaplan-Meier survival curves were digitized, IPD reconstructed, and pooled analyses performed. Meta-regression was conducted on the pooled population.

A total of 6604 matched patients from 14 studies were included (TAVR: 3298; SUAVR: 3306). TAVR was associated with lower long-term survival (52.5% vs. 64.6% at 9 years; hazard ratio = 1.48, 95% CI: 1.27-1.72; P < 0.001), higher 30-day mortality [odds ratio (OR) = 2.26, 95% CI: 1.36-3.76], and increased rates of permanent pacemaker implantation (PPI; OR = 1.85, 95% CI: 1.10-3.10) and moderate-or-greater paravalvular leak (PVL; OR = 4.46, 95% CI: 2.58-7.71). In contrast, mean pressure gradient (mean PG) was lower with TAVR (standardized mean difference = -0.52, 95% CI: -0.75 to -0.29). Meta-regression suggested that higher rates of PPI, prosthesis-patient mismatch, and moderate-or-greater PVL may attenuate the survival advantage of SUAVR, although the magnitude of this effect appeared modest.

SUAVR was associated with superior long-term survival and favorable early outcomes compared with TAVR, whereas mean PG favored TAVR. These findings suggest that SUAVR may mitigate the surgical trauma inherent to conventional AVR, narrowing the gap with TAVR, and the choice of TAVR or SUAVR should be carefully individualized, especially in patients with longer life expectancy.