Transcatheter Versus Sutureless Aortic Valve Replacement: A Propensity-Matched Single-Center Cohort Study

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVI) is now standard for all risk groups.
• The Perceval sutureless valve excels in minimally invasive surgery.
• Long-term data and patient selection criteria for both TAVI and Perceval remain limited.

Purpose of the Study:

• To compare outcomes of isolated aortic valve replacement (AVR) using the Perceval sutureless valve versus TAVI.
• To evaluate long-term safety and efficacy of these two AVR methods.
• To identify factors influencing patient selection for Perceval or TAVI.

Main Methods:

• Retrospective analysis of 1006 patients undergoing isolated AVR (April 2013-December 2024).
• Propensity score matching created 197 pairs comparing TAVI (424) and Perceval (582).
• Primary endpoints: all-cause and cardiovascular mortality. Secondary endpoints: acute kidney injury, pacemaker implantation, stroke, effusion, and length of stay.

Main Results:

• Perceval showed significantly lower paravalvular leak rates (2.5% vs. 23.4%) and less aortic regurgitation at 6-12 months.
• TAVI had higher mean transvalvular gradients, especially in smaller valve sizes.
• Perceval implantation resulted in shorter ICU and hospital stays, but TAVI had numerically higher pacemaker implantation rates (11.2% vs. 5.6%).
• One-year mortality was higher after TAVI (16.2% vs. 9.1%), with Perceval demonstrating superior overall survival (p < 0.001).

Conclusions:

• Perceval sutureless valve implantation was associated with better long-term overall survival compared to TAVI in propensity-matched patients.
• Higher rates of paravalvular leaks after TAVI correlated with poorer survival outcomes.
• Personalized treatment strategies, guided by a multidisciplinary heart team, are crucial for optimizing aortic valve replacement outcomes.