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Heart Vessels. 2016 Mar;31(3):427-33. doi: 10.1007/s00380-014-0623-3. Epub 2015 Jan 9.

Immediate outcome after sutureless versus transcatheter aortic valve replacement.

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Department of Surgery, Oulu University Hospital, PL 21, 90029, OYS, Oulu, Finland.
Cardiology Unit, Ferrarotto Hospital, University of Catania, Catania, Italy.
Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Oulu University Hospital, PL 21, 90029, OYS, Oulu, Finland.
Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.


The aim of this study was to compare the immediate outcome of patients undergoing transcatheter (TAVI) versus surgical aortic valve replacement with the sutureless Perceval bioprosthesis (SU-AVR). This is a retrospective multicenter analysis of 773 patients who underwent either TAVI (394 patients, mean age, 80.8 ± 5.5 years, mean EuroSCORE II 5.6 ± 4.9 %) or SU-AVR (379 patients, 77.4 ± 5.4 years, mean EuroSCORE II 4.0 ± 3.9 %) with or without concomitant myocardial revascularization. Data on SU-AVRs were provided by six European institutions (Belgium, Finland, Germany, Italy and Sweden) and data on TAVIs were provided by a single institution (Catania, Italy). In-hospital mortality was 2.6 % after SU-AVR and 5.3 % after TAVI (p = 0.057). TAVI was associated with a significantly high rate of mild (44.0 vs. 2.1 %) and moderate-severe paravalvular regurgitation (14.1 vs. 0.3 %, p < 0.0001) as well as the need for permanent pacemaker implantation (17.3 vs. 9.8 %, p = 0.003) compared with SU-AVR. The analysis of patients within the 25th and 75th percentiles interval of EuroSCORE II, i.e., 2.1-5.8 %, confirmed the findings of the overall series. One-to-one propensity score-matched analysis resulted in 144 pairs with similar baseline characteristics and operative risk. Among these matched pairs, in-hospital mortality (6.9 vs. 1.4 %, p = 0.035) was significantly higher after TAVI. SU-AVR with the Perceval prosthesis in intermediate-risk patients is associated with excellent immediate survival and is a valid alternative to TAVI in these patients.


AVR; Aortic valve replacement; Perceval; Sutureless; TAVI; Transcatheter

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