SUTURELESS VERSUS TRANSCATHETER AORTIC VALVES IN ELDERLY PATIENTS WITH AORTIC STENOSIS AT INTERMEDIATE RISK: A MULTI-INSTITUTIONAL STUDY

Abstract Objective This multi-institutional study compares the long-term outcome of elderly patients with severe aortic stenosis at intermediate risk profile undergoing sutureless(SV) versus Transcatheter(TAVI) aortic valve implantation. Methods From 2008 to 2015, 967 elderly patients(>75 years-old) at intermediate risk (STS score 4%-8%) and isolated aortic stenosis were included in the study(SV=481/TAVI=486). After Propensity Score matching, two matched groups of 291 patients were obtained. Transcatheter valve implanted were CoreValve, Edwards SAPIEN-XT and Acurate-TA. Primary endpoints included all-cause of death at 30-days and at 5-years. Secondary endpoints included early and 5-year incidence of composite adverse events (MACCEs: all-cause death,stroke,PM implant, MI, paravalvular-leak≥II, re-operation). Results After matching there were no substantial differences between groups. The 30-days mortality was significantly lower in SV group (SV=1.7% vs TAVI=5.5%;p=0.024) as well as the rate of permanent PM implantation (SV=5.5% vs TAVI=10.7%,p=0.032). Stroke/TIA cumulative incidence at five years was 1.4% in SV and 5.3% in TAVI(p=0.010). Incidence of perivalvular leak ≥ grade II was 1.3% in SV and 9.8% in TAVI(p Conclusion Sutureless valves improved outcomes of aortic stenosis in elderly patients at intermediate risk profile when compared to TAVI. The use of TAVI in this subset population should be evaluated in further controlled randomized trial having sutureless valves as comparative cohort.