Clinical Outcome and Cost Analysis of Sutureless Versus Transcatheter Aortic Valve Implantation With Propensity Score Matching Analysis

In this manuscript the authors report on the results of a retrospective propensity score analysis in 102 matched pairs of patients, considered to be in a “grey zone” of surgical risk for either TAVI (Edwards Sapiens, Medtronic CoreValve or Symetis Acurate TA prosthesis) or aortic valve replacement (AVR) with a sutureless prosthesis (Sorin Perceal). There were no significant differences in intra-procedural complications, postoperative renal, neurological or respiratory complications and the need for pacemaker between the patients undergoing TAVI and sutureless AVR. Patients receiving TAVI had shorter ICU and hospital stay, and required less blood transfusion, but suffered vascular complications significantly more frequently than patients receiving a sutureless prosthesis. There was no significant difference in hospital mortality. At follow up, paravalvular leak was more frequent in the TAVI group. Survival rate was significantly better in the sutureless AVR group. Outcomes regarding the cost associated to the two procedures showed than when the cost of the device was included, sutureless AVR resulted as a cost-saving treatment compared with TAVI.