1. A Multicenter Propensity-score Analysis Of 991 Patients With
Severe Aortic Stenosis And Intermediate-high Risk Profile:
Conventional Surgery versus Sutureless Valves versus TAVR
Claudio Muneretto, Ottavio Alfieri, Michele De Bonis, Roberto Di Bartolomeo, Gianluigi Bisleri, Carlo Savini, Gianluca Folesani, Lorenzo Di Bacco, Manfredo Rambaldini, Juan Pablo Maureira, Francois Laborde, Maurizio Tespili, Alberto Repossini, Thierry A Folliguet
University of Brescia Medical School,, Italy, San Raffaele University Hospital, Italy, University of Bologna, Italy, Azienda Ospedaliera Carlo Poma, Italy, CHU de Nancy, France, Institut Mutualiste Montsouris, France, Ospedale Bolognini di Seriate, Italy, Centre Hospital-Universitaire Brabois ILCV, France
BACKGROUND
Surgical treatment still represents the gold standard for aortic stenosis, while TAVR today is an effective alternative for high risk or inoperable patients
Nawadays there is a trend for a more extensive use of TAVR in intermediate–high risk patients with any or limited evidence –base data
The recent introduction of Sutureless valves may represent an additional tool to improve results of surgery
METHODS
Multicenter observational propensity match study on 991 patients: 336 surgical AVR, 288 Sutureless AVR, 367 TAVR (after propensity match 204 from each group)
Primary endpoint: 30-days mortality and overall survival at 24 months
Secondary endpoints: overall freedom -composite endpoint (MACCE according to VARC – VARC 1 definition )

2. 24 Months freedom from MACCE and AR>II
RESULTS
DISCUSSION
Patients with severe aortic stenoses and intermediate risk profile undergoing TAVR
showed a significant worse outcome when compared with conventional surgery and
Sutureless valve
TAVR was a strong indipendent predictor for all-causes mortality
The deliberate use of TAVR in patients with intermediate risk profile shoul be restricted in
further indipendent CRTs
AVR
SUTURELESS
TAVR
P-VALUE
BLEEDING WITH REVISION
6 (3%)
10 (4,8%)
0 (0%)
0.008
ANAEMIA REQUIRING AT LEAST 2 UNITS OF RBC
116 (57%)
73 (35,7%)
67 (32,8%)
<0.001
ACUTE RENAL FAILURE
30 (14,7%)
11 (5,3%)
24 (11,7%)
0.007
CVVH
7 (3,4%)
3 (1,5%)
12 (5,8%)
0.06
STROKE
6 (2,9%)
4 (1,9%)
0.6
VASCULAR COMPLICATIONS
20 (9,8%)
PM IMPLANTATION
8 (3,9%)
30 (14.7%)
30-DAYS MORTALITY
20 (9.8%)
0.005
Post-operative Outcomes
Composite endpoint
24 Months freedom from MACCE and AR>II