Objective

Sutureless aortic valve implantation is feasible alternative in surgical patients. Comparative evidence against established practices such as surgical AVR and TAVI is lacking, limiting assessment of safety and efficacy.

Methods

Medline search for available evidence was undertaken. Outcomes analysed were mortality, risk of stroke, myocardial infarction, renal failure, paravalvular leak, need for permanent pacemaker and re-do AVR. Odd ratios were pooled using random-effect model. A Trial Sequential Analysis was undertaken to quantify statistical reliability of cumulative evidence. Mortality risk reduction vs. standard AVR was set at 20% and required information size calculated as 22911.

Results

Twelve observational studies were included. Sutureless AVR had no effect on mortality vs. standard AVR, OR (95 percent CI) 0.83 (0.48, 1.44) but reduced risk of mortality vs. TAVI, OR 0.30(0.12,0.77). Sutureless AVR was associated with increased risk of permanent pacemaker insertion 1.94 (1.15, 3.28) compared to standard AVR, and less risk of paravalvular leak vs. TAVI 0.26 (0.11, 0.60). Trial sequential analysis suggested inconclusive evidence.

Conclusion

Observational evidence suggests relative superiority of sutureless AVR vs. TAVI but is inconclusive vs. standard AVR in matched patients. Currently, further high quality evidence is required to lend support to future recommendations.