Transfemoral Transcatheter Aortic Valve Implant versus Sutureless Replacement: A Follow-up Study with Matched Populations

Objectives: The transfemoral transcatheter aortic valve implantation (TF-TAVI) is increasingly performed in patients considered in the “gray zone” between TAVI and surgery. However, the best treatment option in this patient population remains to be established.

Methods: Since 2010, a total of 923 patients underwent TAVI (n = 538) or sutureless aortic valve replacement (AVR) (n = 385). Among these, 79 patients treated with TF-TAVI were compared with 79 propensity score-matched patients who had undergone elective isolated AVR with the sutureless Perceval bioprosthesis ([Table 1]).

Results: In-hospital mortality did not significantly differ between patients who underwent sutureless AVR or TF-TAVI (0 vs. 3 [3.8%]; p = 0.123). Similarly, postoperative complications were comparable between groups. Atrioventricular block requiring postoperative pacemaker implantation occurred in 7 patients (9.2%) of the sutureless group and in 8 patients (11.1%) of the TF-TAVI group (p = 0.455). The use of blood products varied between groups in terms of red blood cell transfusions (1.7 ± 2 vs. 0.3 ± 0.9 units in the sutureless vs. TF-TAVI group, p < 0.001). Paravalvular leakage at discharge was present in 3 patients(3.8%) of the sutureless group and in 26 patients (32.9%) of the TF-TAVI (p < 0.001). Mean follow-up was longer for sutureless AVR(36 ± 21 vs. 27 ± 20 months, p = 0.003). Survival rates were 97.5 and 84.8% in the sutureless vs. TF-TAVI group, respectively (p = 0.001).

Conclusion: Both TF-TAVI and sutureless AVR are well standardized, safe and effective procedures. TF-TAVI seems to be a valuable alternative to surgical AVR for frail patients, reducing the need for perioperative blood transfusion, whereas in patients with a favorable long-term survival outcome, minimally invasive AVR remains the procedure of choice, as it is associated with better long-term results.

Table 1

Variable	Sutureless	TF-TAVI	p Value
Age (years)	78 ± 5	78 ± 8	0.83
Logistic EuroSCORE	15 ± 13	13 ± 8	0.18
Pulmonary hypertension	12 (15)	14 (18)	0.41
Redo	12 (15)	8 (10)	0.24
Poor mobility	15 (19)	9 (11)	0.13
Peripheral arterial disease	3 (4)	5 (6)	0.36
Stroke	3 (4)	4 (5)	0.50
Diabetes on insulin therapy	6 (8)	8 (10)	0.39
Renal insufficiency	20 (25)	27 (34)	0.31