Comparison of Sutureless Aortic Valve Replacement and Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis of Propensity Score Matching

Background: To evaluate the clinical outcomes of sutureless aortic valve replacement (SUAVR) and transcatheter aortic valve implantation (TAVI). Methods: We systematically searched the electronic database and the Clinical Trials Registry up to 31 February 2023. Random effects model risk ratio (RR) and mean differences (MD) with corresponding 95% confidence intervals (CIs) were pooled for the clinical outcomes. Results: The included 16 studies using propensity-matched analysis consisted of 6516 patients, including 3258 patients in the SUAVR group and 3258 patients in the TAVI group. The SUAVR group had lower mortality than the TAVI group at 1-year [RR = 0.53, 95% CI (0.32, 0.87), I-2 = 49%, p = 0.01], 2-year [RR = 0.56, 95% CI (0.37, 0.82), I-2 = 51%, p = 0.03] and 5-year [RR = 0.56, 95% CI (0.46, 0.70), I-2 = 0%, p < 0.01]. The SUAVR group had a significantly lower rate of new permanent pacemaker implantation (PPI) [RR = 0.74, 95% CI (0.55, 0.99), I-2 = 48%, p = 0.04], moderate-to-severe paravalvular leak (PVL) [RR = 0.18, 95% CI (0.11, 0.30), I-2 = 0%, p < 0.01], more-than-mild residual aortic regurgitation (AR) [RR = 0.27, 95% CI (0.14, 0.54), I-2 = 0%, p < 0.01]. In addition, the SUAVR group had a higher rate of new-onset atrial fibrillation (AF) [RR = 3.66, 95% CI (1.95, 6.89), I-2 = 84%, p < 0.01], major or life-threatening bleeding event [RR = 3.63, 95% CI (1.81, 7.28), I-2 = 83%, p < 0.01], and higher postoperative mean aortic gradient [MD = 1.91, 95% CI (0.73, 3.10), I-2 = 91%, p < 0.01] than the TAVI group. Conclusions: The early and mid-term clinical outcomes of SUAVR were superior compared to TAVI. Further studies should be conducted to highlight the specific subgroups of patients. that will benefit from each technique.