Surgical Sutureless and Sutured Aortic Valve Replacement in Low-risk Patients

Ka Yan Lam, Michael J. Reardon, Steven J. Yakubov, Thomas Modine, Stephen Fremes, Pim A.L. Tonino, M. Erwin Tan, Thomas G. Gleason, J. Kevin Harrison, G. Chad Hughes, Jae K. Oh, Stuart J. Head, Jian Huang, G. Michael Deeb

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND: Randomized clinical trials have shown that transcatheter aortic valve replacement is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial.

METHODS: The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding transcatheter aortic valve replacement or surgery. Use of sutureless or sutured valves was at the surgeons' discretion.

RESULTS: Six hundred eighty patients underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The Valve Academic Research Consortium-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P = .93). All-cause mortality between groups was similar at 30 days (0.5% vs 1.5%, P = .28) and 1 year (3.3% vs 2.6%, P = .74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P = .65) and 1 year (2.6% vs 2.2%, P = .76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P < .001). Aortic valve-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P = .04). Mean gradients 1 year after sutureless and sutured aortic valve replacement were 9.9 ± 4.2 versus 11.7 ± 4.7 mm Hg (P < .001).

CONCLUSIONS: Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics but with an increased rate of pacemaker implantation and valve-related hospitalizations.

Original languageEnglish (US)
Pages (from-to)616-622
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number2
StatePublished - Feb 2022


  • Aged
  • Aortic Valve/surgery
  • Aortic Valve Stenosis/diagnosis
  • Female
  • Global Health
  • Humans
  • Incidence
  • Male
  • Postoperative Complications/epidemiology
  • Prosthesis Design
  • Risk Assessment/methods
  • Risk Factors
  • Severity of Illness Index
  • Suture Techniques
  • Sutureless Surgical Procedures/methods
  • Transcatheter Aortic Valve Replacement/methods
  • Treatment Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery


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