Stented Versus Sutureless Bioprostheses In Patients With Chronic Kidney Disease Undergoing Surgical Aortic Valve Replacement: Results From A Multicenter Study

OBJECTIVE: Patients with preoperative chronic kidney disease (CKD) are considered high-risk surgical candidates. This retrospective multicenter study aimed to compare short-term clinical and hemodynamic outcomes between stented and sutureless bioprostheses in CKD patients undergoing isolated surgical aortic valve replacement (SAVR), addressing the limited data on prosthesis performance in this population. METHODS: The study included patients with CKD who underwent isolated SAVR between January 2019 and December 2024. Based on bioprosthesis type, they were divided into STE and SUT groups. Primary endpoints were postoperative mortality and the incidence of acute kidney injury (AKI). Secondary endpoints included early hemodynamic performance and outcomes according to VARC-3 criteria. Statistical analyses included non-parametric hypothesis tests, Chi-squared/Fisher’s exact tests, linear regression. RESULTS: 147 patients with CKD were analyzed: STE (n=86; 58.5%) and SUT (n=61; 41.5%) groups. Baseline characteristics were different between STE and SUT groups, respectively: median age 74 [IQR: 8.9] versus 77 [IQR: 7] years (p=0.009); STS score 1.7 [IQR: 1.3] versus 2.1 [IQR: 1.2] (p=0.026); eGFR 46 versus 50 (p=0.005); CPB time 83 [IQR: 30] vs. 110 [IQR: 37] minutes (p<0.001); ACC time 58 [IQR: 20] vs. 84 [IQR: 28] minutes (p<0.001). Discharge mortality occurred in 6 patients (4%), all within STE group (6.9%; p=0.078). Postoperative AKI occured in 62% of patients overall, with a higher incidence in STE group (92.7% vs. 24.6%; p<0.001). AKI severity was lower in SUT group (p<0.001), logistic regression showed a reduced risk of AKI (OR=0.017; 95% CI:0.004-0.098; p<0.001). SUT demonstrated lower mean postoperative gradients (10 mmHg [IQR: 5] vs. 13 mmHg [IQR: 7]; p<0.05). CONCLUSIONS: In CKD patients undergoing isolated SAVR, sutureless bioprostheses were associated with lower postoperative AKI incidence and severity, and better short-term hemodynamic performance, suggesting sutureless bioprotheses may represent the best therapeutic option for these patients. Long-term randomized studies are needed to confirm these findings.