OBJECTIVES Aortic valve replacement (AVR) using sutureless technology is a feasible alternative in surgical patients. Comparative evidence against established strategies such as conventional AVR and transcatheter AVR is lacking, limiting the assessment of safety and efficacy. METHODS Medline search for available evidence was undertaken. The outcomes analysed were 30-day mortality, risk for stroke, myocardial infarction, renal failure, paravalvular leak and need for permanent pacemaker. Odds ratios were pooled using fixed- and random-effect models. A trial sequential analysis was undertaken to assess the statistical reliability of cumulative evidence. RESULTS Twelve studies of moderate methodological quality were included. Sutureless AVR was associated with at least 30% reduction in 30-day mortality versus transcatheter AVR [odds ratio (95% confidence interval) 0.40 (0.25, 0.62); P < 0.001] primarily in the low- and intermediate-risk population and a similar reduction in the risk for paravalvular leak [0.13 (0.09, 0.17); P < 0.001]. There was no reduction in the risk for 30-day mortality versus conventional AVR [1.03 (0.56, 1.88); P = 0.93]. There was evidence in favour of conventional AVR with at least 50% risk reduction in pacemaker implantation against sutureless technology. There was absence of either benefit or harm vis-à-vis risk for renal injury or stroke due to lack of required information size. CONCLUSIONS Current evidence suggests risk reduction in 30-day mortality with sutureless AVR versus transcatheter AVR but is inconclusive versus standard AVR in matched patients. Robust randomized evidence is lacking to lend support to any potential recommendation.