In-Hospital Mortality and Risk Prediction in Minimally Invasive Sutureless versus Conventional Aortic Valve Replacement

OBJECTIVE: Available evidence suggests that a minimally invasive approach with the use of sutureless bioprostheses has a favorable impact on the outcome of patients undergoing aortic valve replacement (AVR).

METHODS: From 2010 to 2019, 2732 patients underwent conventional AVR through median sternotomy with a stented bioprosthesis (n = 2048) or minimally invasive AVR with a sutureless bioprosthesis (n = 684).

RESULTS: Using the propensity score, 206 patients in each group were matched, and the matched groups were well balanced regarding preoperative risk factors. Both unmatched and matched patients of the sutureless + minimally invasive group showed significantly shorter cross-clamp times and longer ICU stay. In-hospital mortality was the only outcome measure that was confirmed in both analyses, and was higher in the stented + conventional group (2.54% and 2.43% in unmatched and matched patients, respectively) compared with the sutureless + minimally invasive group (0.88% and 0.97% in unmatched and matched patients, respectively) (p = 0.0047 and p < 0.0001, respectively). No differences in postoperative pacemaker implantation were recorded in matched patients of both groups (n = 2 [1%] in the stented + conventional group vs. n = 4 [2%] in the sutureless + minimally invasive group; p = 0.41). The discrimination power of EuroSCORE II was not confirmed in the sutureless + minimally invasive group, yielding an area under the ROC curve of 0.568.

CONCLUSIONS: Minimally invasive sutureless AVR has a favorable impact on the immediate outcome and is associated with significantly lower in-hospital mortality rates compared with conventional AVR, resulting in the absence of the discrimination power of EuroSCORE II for predicting AVR outcomes.