Surgical Sutureless and Sutured Aortic Valve Replacement in Low-risk Patients.

Journal Article (Journal Article;Multicenter Study)

BACKGROUND: Randomized clinical trials have shown that transcatheter aortic valve replacement is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial. METHODS: The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding transcatheter aortic valve replacement or surgery. Use of sutureless or sutured valves was at the surgeons' discretion. RESULTS: Six hundred eighty patients underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The Valve Academic Research Consortium-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P = .93). All-cause mortality between groups was similar at 30 days (0.5% vs 1.5%, P = .28) and 1 year (3.3% vs 2.6%, P = .74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P = .65) and 1 year (2.6% vs 2.2%, P = .76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P < .001). Aortic valve-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P = .04). Mean gradients 1 year after sutureless and sutured aortic valve replacement were 9.9 ± 4.2 versus 11.7 ± 4.7 mm Hg (P < .001). CONCLUSIONS: Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics but with an increased rate of pacemaker implantation and valve-related hospitalizations.

Full Text

Duke Authors

Cited Authors

  • Lam, KY; Reardon, MJ; Yakubov, SJ; Modine, T; Fremes, S; Tonino, PAL; Tan, ME; Gleason, TG; Harrison, JK; Hughes, GC; Oh, JK; Head, SJ; Huang, J; Deeb, GM

Published Date

  • February 2022

Published In

Volume / Issue

  • 113 / 2

Start / End Page

  • 616 - 622

PubMed ID

  • 33794164

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2021.03.048

Language

  • eng

Conference Location

  • Netherlands