1. Figure 1: A PRISMA schematic of search strategy
Figure 1: A PRISMA schematic of search strategy. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

2. Figure 2: Compliance with the STROBE checklist
Figure 2: Compliance with the STROBE checklist. Solid black boxes represent domains that were complied with by individual studies. STROBE: STrengthening the Reporting of OBservational studies in Epidemiology; FU: follow-up; RR: relative risk.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

3. Figure 3: Propensity-matched outcomes comparison: SU-AVR versus TAVI
Figure 3: Propensity-matched outcomes comparison: SU-AVR versus TAVI. Forest plots displaying primary and secondary outcomes with effect estimates and heterogeneity (I², P-value). The X-axis of both graphs represents an arbitrary range based on the width of CIs. The pooled effect estimates displayed on the right-hand side were derived according to the Peto fixed-effects model (dichotomous outcomes) and inverse variance method (continuous outcomes), respectively. ARF: acute renal failure; CI: confidence interval; CVA: cerebrovascular accidents; ICU: intensive care unit; na, not applicable as single study; RRT: renal replacement therapy; SU-AVR: sutureless aortic valve replacement; TAVI: transcatheter aortic valve implantation.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

4. Figure 4: Forest plot of risk for 30-day mortality comparison: SU-AVR versus TAVI. CI: confidence interval; SU-AVR: sutureless aortic valve replacement; TAVI: transcatheter aortic valve implantation.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

5. Figure 5: Trial sequential analysis based on 6 observational studies comparing SU-AVR versus transcatheter aortic valve replacement and risk for 30-day mortality. The X-axis indicates the cumulative number of patients (i.e. 2714). Starting point of the z-curve (blue line) is always at x = 0, i.e. inclusion of no studies. Horizontal brown line depicts conventional boundary (Alpha; P = 0.05), whereas the funnel-shaped outer boundary represents trial sequential analyses adjusted boundaries calculated according to the O’Brien–Fleming alpha-spending function. Vertical line towards the right of the graph shows trial sequential analyses-adjusted required information size. The small triangle towards the right represents futility zone; futility is the proof of no effectiveness (i.e. demonstration of both non-superiority and non-inferiority). The intervention effect was set as RRR of 30%, α = 0.05 (2 sided) and β = 0.20 (power 80%). RRR: relative risk reduction; SU-AVR: sutureless aortic valve replacement; TAVI: transcatheter aortic valve implantation.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

6. Figure 6: Propensity-matched outcomes comparison: SU-AVR versus conventional surgery. Forest plots displaying primary and secondary outcomes with effect estimates and heterogeneity (I², P-value). The X-axis of both graphs represents an arbitrary range based on the width of CIs. The pooled effect estimates displayed on the right-hand side were derived according to the Peto fixed-effects model (dichotomous outcomes) and inverse variance method (continuous outcomes), respectively. ARF: acute renal failure; CI: confidence interval; conAVR: conventional aortic valve replacement; CVA: cerebrovascular accident; ICU: intensive care unit; RRT: renal replacement therapy; SU-AVR: sutureless aortic valve replacement.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

7. Figure 7: Forest plot of risk for 30-day mortality comparison: SU-AVR versus conventional surgery. CI: confidence interval; conAVR: conventional aortic valve replacement; SU-AVR: sutureless aortic valve replacement.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

8. Figure 8: Trial sequential analysis: based on 5 observational studies comparing SU-AVR versus conventional surgery and the risk for 30-day mortality. The X-axis indicates the cumulative number of patients (i.e. 7161). Starting point of the z-curve (blue line) is always at x = 0, i.e. inclusion of no studies. Horizontal brown line depicts conventional boundary (Alpha; P = 0.05), whereas the funnel-shaped outer boundary represents trial sequential analyses-adjusted boundaries calculated according to the O’Brien–Fleming alpha-spending function. Vertical line towards the right of the graph shows trial sequential analyses-adjusted required information size. The small triangle towards the right represents futility zone; futility is the proof of no effectiveness (i.e. demonstration of both non-superiority and non-inferiority). The intervention effect was set as RRR of 30%, α = 0.05 (2 sided) and β = 0.20 (power 80%). convAVR: conventional aortic valve replacement; RRR: relative risk reduction; SU-AVR: sutureless aortic valve replacement.
From: Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement
Eur J Cardiothorac Surg. Published online September 12, doi: /ejcts/ezx307
Eur J Cardiothorac Surg | © The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.