OBJECTIVES: Aortic valve replacement (AVR) is the most common heart valve operation, accounting for a conspicuous part of all valve surgery performed in the elderly. Prolonged aortic cross-clamping times  are an independent risk factor. Perceval S is a new aortic valve which is implanted without need for suturing and a collapsed profile, thus allowing a significant reduction of cross-clamping times and to expand the pool of patients operable with mini-invasive aortic valve replacement (MiAVR) among isolated AVR candidates. Aim of this simulation study was to predict costs and outcomes of isolated AVR procedures associated with this new valve in Germany, as compared to traditional valve implants, from the cost perspective of the third party payer. METHODS: A previously published probabilistic, patient-level simulation model fully coded in WinBugs was updated with new clinical data and the evaluation extended to evaluate lifetime cost-effectiveness from the perspective of the third party payer. Unit costs and health state-specific utilities were retrieved from official and literature sources; the price of the sutureless valve is hypothesised twice as much as for traditional valves. Future costs and outcomes are discounted at a yearly 3.5% rate.  RESULTS: The model predicts that on average the use of the Perceval S in MiAVR instead of traditional sutured valves in full sternotomy among isolated AVR candidates, would yield incremental 0.29 LYs (0.20 QALYs) per patient, with an associated saving around 3,500 €, thus representing a dominant option when compared to traditional surgical AVRs. In concomitant procedures, on average the use of the Perceval S valve instead of traditional sutured valves is expected to yield incremental 0.21 LYs (0.16 QALYs) per patient, with an associated saving of  over 4,400 €, also representing a dominant alternative. CONCLUSIONS: Sutureless valves may improve outcomes in AVR at a reduced cost to the third party payers.