OBJECTIVES: New sutureless aortic valve prostheses reduce the surgical time. Objective of this study is to asses if shorter operative times may also result in improved patient outcomes and the impact on the hospital costs. METHODS: Records of 547 patients that underwent aortic valve replacement with a bioprosthesis from March 2009 and May 2013 were identified. Based on a propensity score analysis 2 groups (Sutureless and Sutured) with 82 matched pairs were created from the 112 patients received a Perceval sutureless bioprosthesis and  the 435 patients received a sutured valve. Hospital and follow up outcomes, resources consumption was recorded and compared between groups. Analysis was performed according the National Health Care system perspective RESULTS: Preoperative characteristics and risk scores of the 2 groups were comparable. Hospital mortality was 3.7% in Sutured and 2.4% in Sutureless (p=0.65). Aortic cross-clamp, cardiopulmonary bypass time and operation time were 20%, 23% and 16% shorter in Sutureless (each one p<0.001).Sutureless  required less blood transfusion (1.2±1.3 vs 2.5±3.7 units, p=0.005) with a similar incidence of postoperative bleeding (2 patients vs 5, p=0.221). Sutureless had a shorter intensive care unit stay (2.0±1.72vs 2.8±1.3 days, p<0.001), a shorter hospital stay (11.4±3.9 vs 17.3±13.7 days, p<0.001) and a shorter intubation time (9.5±4.6 vs 16.6±6.4 hours, p<0.001). A neurological event was recorded in 3 sutureless patients and in 6 sutures (p=0.248). Sutured has an higher incidence of postoperative atrial fibrillation, pleura effusions and respiratory insufficiency (p 0.015, 0.024 and 0.016, respectively). Reduced risk of post operative complication resulted in a dramatic reduction of resources consumption in the sutureless group allowing a saving of 50% of the complication related resource use. CONCLUSIONS: Shorter procedural times resulting from sutureless aortic valve replacement are associated with better outcomes and lower costs. Sutureless valve may be considered as the first-line treatment for patients underwent aortic valve replacement with a bioprosthesis.