Aortic valve replacement (AVR) has seen significant advancements with the introduction of sutureless valves nearly a decade ago. These valves promised to improve surgical outcomes, reduce postoperative complications, and facilitate minimally invasive approaches. This summary focuses on the critical evaluation of the methodology and results of the extensive review recently published in JACC that encompasses all major studies investigating the efficacy and safety of these valves compared to conventional aortic valve replacement.

In the referenced article, a systematic literature review was performed, including only two randomized clinical trials (only one with a substantial sample size), one weighted study, and mostly retrospective observational studies comparing sutureless or rapid deployment prostheses, such as Perceval® and Intuity®, with conventional valves. Studies reporting data on 30-day mortality, postoperative complications, and long-term outcomes (within the limitations of analyzing prostheses with just a decade of usage in our setting) were included. The search was conducted in databases such as PubMed, Cochrane Library, and ClinicalTrials.gov, using specific terms related to sutureless aortic valves.

The methodologies of the reviewed studies varied, but many employed multicenter designs, increasing the external validity of the findings. However, limitations were observed in some studies, such as sample size and heterogeneity of patient populations. Most studies included patients with severe aortic stenosis, excluding those with significant comorbidities that could affect outcomes.

The reviewed results indicate that sutureless valves may offer advantages in terms of perioperative times and reduced need for blood transfusions. Specifically, a reduction in aortic cross-clamp time and overall surgery duration was reported, which we know can directly contribute to faster postoperative recovery. Additionally, 30-day mortality rates were comparable between sutureless and conventional valves, suggesting that the safety of these valves is acceptable.

Regarding postoperative complications, studies showed a lower incidence of reintervention-requiring postoperative bleeding in patients receiving sutureless valves. However, some research highlighted an increase in the incidence of mild-to-moderate valvular dysfunction during long-term follow-up, raising questions about the durability of these valves compared to conventional ones.

Long-term results, though promising, require extended follow-up to evaluate the functionality and durability of sutureless valves. Some studies have reported similar reintervention rates between the two groups, but the lack of long-term data in broader populations limits the ability to draw definitive conclusions.

In summary, the evidence suggests that sutureless aortic valves may be a viable and safe option for aortic valve replacement, with potential benefits in surgical time and postoperative complications. However, further research is needed to address concerns regarding the durability and long-term function of these valves compared to traditional techniques.

COMMENTARY:

The literature review on sutureless aortic valves reveals an encouraging landscape regarding their efficacy and safety. The methodologies employed in the analyzed studies, although varied, generally rely on multicenter designs that strengthen the validity of the results. However, it is crucial to consider the inherent limitations of these studies, such as sample size and heterogeneity of the populations, which may influence the generalizability of the findings.

The results indicate that sutureless valves offer significant operative advantages, such as reduced aortic cross-clamp time and decreased need for blood transfusions. These aspects are particularly relevant as it is widely demonstrated in our specialty that minimizing surgical trauma can translate into faster recovery and fewer complications.

Despite the excellent results, concerns about long-term valvular dysfunction and durability of these valves must not be underestimated. The need for prolonged follow-up is evident, and therefore, more studies focused on prosthetic valve degeneration for this type of prosthesis are required.

REFERENCE:

Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, et al. Sutureless Valves, a “Wireless” Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024 Jul 23;84(4):382-407. doi: 10.1016/j.jacc.2024.05.031.