Ajay Yadlapati1, Jimmy Diep2, MaryJo Barnes3, Tristan Grogan4, Daniel M Bethencourt3, Gabriel Vorobiof5. 1. Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California. 2. Department of Medicine, Division of Cardiology, University of California Irvine, Irvine, California. 3. Long Beach Memorial Medical Center, Heart & Vascular Institute, Long Beach, California. 4. Department of Medicine, Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California. 5. Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: gvorobiof@mednet.ucla.edu.
Abstract
BACKGROUND: Patient-prosthesis mismatch (PPM) has been reported with a wide range of bioprosthetic valves after aortic valve replacement (AVR) and has been associated with multiple adverse outcomes. The aim of this study was to test the hypothesis that a novel low-profile stented pericardial tissue bioprosthesis for AVR, the Trifecta aortic valve, would have superior hemodynamics, a lower incidence of PPM, and an improvement in clinical outcomes. Its hemodynamic performance was evaluated, and a comparison was performed with a traditional stented pericardial bioprosthesis (Epic) with respect to hemodynamics, PPM, and clinical events. METHODS: One hundred twenty-four patients (mean age, 73.6 ± 11.0 years) underwent AVR. Prosthetic valve types used were Trifecta (n = 75 [60.5%]) and Epic (n = 49 [39.5%]). Intraoperative transesophageal echocardiography was used to evaluate hemodynamic variables before and after AVR. RESULTS: Postoperative comparison of the Epic valve and the Trifecta valve revealed a lower mean pressure gradient (16.5 ± 6.7 vs 8.8 ± 3.4 mm Hg, P < .001), a lower peak gradient (33.3 ± 11.8 vs 19.4 ± 8.6 mm Hg, P < .001), and higher indexed effective orifice area (0.8 ± 0.2 vs 1.1 ± 0.4 cm(2)/m(2), P < .001), favoring the Trifecta valve across several valve sizes. Severe PPM (6% vs 27%, P < .001) and valvular-related complications at follow-up (14.3% vs 36.7%, P = .005) were less frequent in the Trifecta group. CONCLUSIONS: The hemodynamic performance of the Trifecta valve is superior to that of the Epic valve across many conventional prosthesis sizes, and its implantation resulted in lower rates of severe PPM. These improvements were associated with lower valvular-related adverse events.
BACKGROUND:Patient-prosthesis mismatch (PPM) has been reported with a wide range of bioprosthetic valves after aortic valve replacement (AVR) and has been associated with multiple adverse outcomes. The aim of this study was to test the hypothesis that a novel low-profile stented pericardial tissue bioprosthesis for AVR, the Trifecta aortic valve, would have superior hemodynamics, a lower incidence of PPM, and an improvement in clinical outcomes. Its hemodynamic performance was evaluated, and a comparison was performed with a traditional stented pericardial bioprosthesis (Epic) with respect to hemodynamics, PPM, and clinical events. METHODS: One hundred twenty-four patients (mean age, 73.6 ± 11.0 years) underwent AVR. Prosthetic valve types used were Trifecta (n = 75 [60.5%]) and Epic (n = 49 [39.5%]). Intraoperative transesophageal echocardiography was used to evaluate hemodynamic variables before and after AVR. RESULTS: Postoperative comparison of the Epic valve and the Trifecta valve revealed a lower mean pressure gradient (16.5 ± 6.7 vs 8.8 ± 3.4 mm Hg, P < .001), a lower peak gradient (33.3 ± 11.8 vs 19.4 ± 8.6 mm Hg, P < .001), and higher indexed effective orifice area (0.8 ± 0.2 vs 1.1 ± 0.4 cm(2)/m(2), P < .001), favoring the Trifecta valve across several valve sizes. Severe PPM (6% vs 27%, P < .001) and valvular-related complications at follow-up (14.3% vs 36.7%, P = .005) were less frequent in the Trifecta group. CONCLUSIONS: The hemodynamic performance of the Trifecta valve is superior to that of the Epic valve across many conventional prosthesis sizes, and its implantation resulted in lower rates of severe PPM. These improvements were associated with lower valvular-related adverse events.
Authors: Giovanni Mariscalco; Silvia Mariani; Samuele Bichi; Andrea Biondi; Andrea Blasio; Paolo Borsani; Fabrizio Corti; Benedetta De Chiara; Riccardo Gherli; Cristian Leva; Claudio Francesco Russo; Giordano Tasca; Paolo Vanelli; Ottavio Alfieri; Carlo Antona; Germano Di Credico; Giampiero Esposito; Amando Gamba; Luigi Martinelli; Lorenzo Menicanti; Giovanni Paolini; Cesare Beghi Journal: J Cardiothorac Surg Date: 2015-11-20 Impact factor: 1.637