Two-Year Outcomes of Sutureless SAVR versus TAVR in Low-Risk Aortic Stenosis

A comparative analysis found similar mortality and stroke rates in sutureless surgical aortic valve replacement (SU-SAVR) versus transcatheter AVR (TAVR) in low-risk patients with aortic stenosis. However, SU-SAVR was associated with a significantly increased risk of subsequent heart failure hospitalization. This study was published in Circulation: Cardiovascular Interventions.

“SU-SAVR has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach,” wrote the study authors. “While some studies have compared the early outcomes of SU-SAVR versus TAVR, most data were obtained in high-risk patients and/or limited to in-hospital outcomes.”

At two centers between 2011 and 2020, 806 consecutive patients with European System for Cardiac Operative Risk Evaluation (EuroSCORE) II scores below 4% (low-risk) were enrolled. Patients underwent either TAVR or SU-SAVR. Baseline characteristics, in-hospital events, and follow-up outcomes were compared.

Between-group baseline characteristics were “well-balanced,” according to the authors. The median EuroSCORE II was 1.9% (range, 1.3-2.5%) in both SU cohorts (P=0.85).

The researchers reported no statistically significant differences in in-hospitality mortality between SU-SAVR and TAVR (4.1% vs. 1.8%, respectively, P=0.199). Similarly, rates of stroke were also comparable (2.3% vs. 2.9%, P=0.736).

By contrast, the SU-SAVR cohort demonstrated greater rates of bleeding and new-onset atrial fibrillation (P<0.001), and higher residual transvalvular gradients (P<0.001) compared with TAVR, while TAVR was associated with an increased rate of pacemaker implantation (P=0.011).

Median follow-up was two years, ranging from one to three. At follow-up, both groups demonstrated comparable rates of all-cause mortality (HR=0.97; P=0.936) and stroke (HR=0.83; P=0.708). SU-SAVR was associated with a nearly five-fold risk of heart failure hospitalization compared with TAVR (HR=5.38; P=0.002).

“In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU-SAVR,” the authors wrote. “Although similar mortality and stroke rates were observed at two-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU-SAVR for the majority of such patients.”