Comparison of Sutureless Bioprosthetic Valve With Surgical or TAVR for SevereAortic Stenosis.

Abstract

Clinical advantages of sutureless rapid-deployment (RD) aortic valve replacement (AVR) for severe aortic valve stenosis (AS) have not been elucidated compared with surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. This study sought to investigate comparative effectiveness and safety of RD-AVR compared with SAVR and TAVR in a prospective cohort of patients with severe AS. The primary outcome was a composite of death, stroke, or rehospitalization at 12months. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Among 1,020 eligible patients, 107 (10.5%) underwent RD-AVR, 437 (42.8%) underwent SAVR, and 476 (46.7%) underwent TAVR. In the matched cohorts of RD-AVR and SAVR (n=107), the incidence of primary composite outcome at 12months was similar between the 2 groups (8.0% vs 10.8%, respectively; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.30-1.84; P=0.52). In the matched cohorts of RD and TAVR (n=58), the incidence of primary composite outcome at 12months did not statistically differ between the 2 groups (9.4% vs 16.2%, respectively; HR:0.53; 95%CI: 0.18-1.57; P=0.25). In this propensity-matched cohort of patients who underwent AVR for severe AS, we did not detectsignificant differences in the rates of the primary composite of death, stroke, or rehospitalization at 12months when comparing RD-AVR with SAVR and TAVR. Because the study was underpowered, the results should be consideredas hypothesis generating highlighting the need for further research. (ASAN Medical Center Aortic Valve Replacement Registry [ASAN-AVR]; NCT03298178).