Balancing risk and innovation: Comparative clinical outcomes of sutureless versus transcatheter aortic valve replacement in Heart Team practice

BACKGROUND: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) have expanded treatment options for severe aortic stenosis, but comparative real-world data remain limited. AIMS: We aimed to compare early and up to 6-month clinical and hemodynamic outcomes of SU-AVR versus transfemoral TAVI. METHODS: All consecutive patients undergoing SU-AVR (n = 53) or TAVI (n = 245) between 2014 and 2023 were retrospectively analyzed. Propensity score matching (1:1 nearest neighbor, no replacement) generated 53 balanced pairs. RESULTS: Paravalvular leak was more frequent after TAVI and was driven by mild leaks (40.0% vs. 13.3%; P = 0.019), while moderate-to-severe paravalvular leak was low and comparable (6.7% vs. 3.3%; P = 0.646). TAVI demonstrated lower transvalvular gradients compared to SU-AVR (P = 0.004); other 6-month echocardiographic parameters, including left ventricular ejection fraction and pulmonary artery pressure, were comparable. Permanent pacemaker implantation rates were comparable. Early mortality did not differ between the SU-AVR and TAVI groups (13.5% vs. 5.7%; P = 0.173). TAVI was associated with shorter hospitalization (median 5.2, interquartile range 3.7-7.3 vs. 8.7, interquartile range 6.3-11.9 days; P