Sutureless aortic valve and TAVI: pros and cons

Aortic valve replacement (AVR) with biological heart valves remains the gold standard for treating operable older patients with symptomatic aortic stenosis. Over the last few years, transcatheter aortic valve implantation (TAVI) has been shown to be superior to medical treatment in high-risk patients with severe aortic stenosis. The transfemoral TAVI route has been also found in randomized controlled trials to be as good as, if not superior to, standard AVR at 5 years in high-risk patients. In intermediate-risk patients, TAVI was found in randomized controlled trials as a non-inferior alternative to surgery, with a different pattern of adverse events associated with each procedure. In retrospective propensity matched analysis, the use of TAVI in patients with an intermediate to high risk profile was associated with a significantly higher incidence of perioperative complications and decreased survival at short and mid-term when compared with conventional surgery and sutureless valve implantation. More data is needed to draw a firm conclusion comparing the two treatments in intermediate-risk patients. Sutureless bioprostheses may represent a viable alternative to standard bioprostheses for intermediate and high-risk patients when having conventional surgery.