SUTURELESS VERSUS CONVENTIONAL AORTIC VALVE REPLACEMENT: COMPARATIVE PATHWAYS IN BIOPROSTHETIC VALVE SURGERY

Introduction: Sutureless bioprosthetic valves have emerged as an alternative to conventional sutured valves in surgical aortic valve replacement (SAVR), aiming to improve operative efficiency and postoperative outcomes, particularly in elderly or high-risk patients. However, concerns remain regarding conduction disturbances and rhythm complications. This study aimed to compare early and midterm outcomes of SAVR using sutureless versus conventional bioprosthetic valves. Methods: This single-center, retrospective observational study included 175 patients who underwent isolated SAVR with either sutureless (n = 72) or conventional sutured (n = 103) bioprosthetic valves. Preoperative characteristics, intraoperative variables, and postoperative outcomes including cardiopulmonary bypass (CPB) time, aortic cross-clamp time, rhythm disturbances, pacemaker requirement, and mortality—were compared between groups. Results: A total of 175 patients underwent bioprosthetic aortic valve replacement, with 72 receiving sutureless and 103 receiving conventional valves. Baseline characteristics were similar between groups, except for a higher proportion of NYHA class III in the sutureless group. Sutureless valve implantation was associated with significantly shorter cardiopulmonary bypass and cross-clamp times (p<0.001). However, postoperative atrial fibrillation and permanent pacemaker requirement were more frequent in the sutureless group (p=0.009 and p=0.037, respectively). Follow-up duration was longer in the sutureless group, while late mortality rates were comparable between groups. Conclusion: Sutureless valve implantation significantly reduces operative times and may enhance surgical efficiency, particularly in elderly patients. However, it is associated with higher rates of permanent pacemaker implantation and postoperative atrial fibrillation.