Abstract
Objective
The Trifecta valve is a recent, newly designed high performance valve, with few studies on the clinical and hemodynamic data. The purpose of this study was to evaluate the early clinical and echocardiographic results of the Trifecta valve.
Methods
Between April 2012 and December 2012, 23 consecutive patients underwent aortic valve replacement with the Trifecta valve in our institution. Clinical and hemodynamic data were prospectively recorded and hemodynamic performance was assessed by transthoracic echocardiography.
Results
Nine patients were male and the overall mean age was 75 ± 9 years. Twenty patients suffered aortic stenosis, and 3 suffered aortic insufficiency. Prosthesis sizes implanted were: 19 mm (n = 4), 21 mm (n = 12), and 23 mm (n = 7). There were no 30-day deaths and no valve-related events during follow-up, except for 1 postoperative stroke. The mean postoperative transprosthetic pressure gradient was 10.0 ± 1.4, 9.6 ± 3.6, and 7.1 ± 3.6 mmHg, and the effective orifice area was 1.45 ± 0.13, 1.68 ± 0.16, and 1.90 ± 0.28 cm2, for valve sizes 19, 21, and 23 mm, respectively. One patient had moderate prosthesis–patient mismatch. No moderate to severe aortic regurgitation was observed. The mean pressure gradient in aortic stenosis patients decreased significantly from 49.9 ± 20.7 to 8.9 ± 3.6 mmHg (p < 0.001). Left ventricular mass index in all patients decreased significantly from 142.0 ± 33.6 to 115.4 ± 26.4 g/m2 (p < 0.001).
Conclusions
The Trifecta aortic bioprosthesis provided satisfactory early outcomes and hemodynamic function.
Similar content being viewed by others
References
Tasca G, Brunelli F, Cirillo M, DallaTomba M, Mhagna Z, Troise G, et al. Impact of valve prosthesis–patient mismatch on left ventricular mass regression following aortic valve replacement. Ann Thorac Surg. 2005;79:505–10.
Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MJ, Takkenberg JJ, et al. The impact of prosthesis–patient mismatch on long term survival after aortic valve replacement: a systemic review and meta-analysis of 34 observational studies comprising 27186 patients with 133141 patient-years. Eur Heart J. 2012;33:1518–29.
Motomura N, Miyata H, Tsukihara H, Takamoto S, Japan Cardiovascular Surgery Database Organization. Risk model of thoracic aorta surgery in 4707 cases from a nationwide single-race population through a web-based data entry system. Circulation. 2008;118:S153–9.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.
Edmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for standardizing definitions of prosthetic heart valve morbidity. Ann Thorac Surg. 1996;62:932–5.
Kuwano H, Amano J, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2010. Gen Thorac Cardiovasc Surg. 2012;60:680–708.
Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP Jr, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48:e1–148.
St. Jude Medical. Trifecta valve, pre-market approval application summary of safety and effectiveness data. P100029, 2011.
Dell’aquila AM, Schlarb D, Schneider SR, Sindermann JR, Hoffmeier A, Kaleschke G, et al. Clinical and echocardiographic outcomes after implantation of the Trifecta aortic bioprosthesis: an initial single-centre experience. Interact Cardiovasc Thorac Surg. 2013;16:112–5.
Bavaria JE, Desai ND, Cheung A, Petracek MR, Groh MA, Borger MA, et al. The St Jude Medical Trifecta aortic pericardial valve: Results from a global, multicenter, prospective clinical study. J Thorac Cardiovasc Surg. 2013. doi:10.1016/j.jtcvs.2012.12.087.
Minardi G, Pulignano G, Del Sindaco D, Sordi M, Pavaci H, Pergolini A, et al. Early Doppler-echocardiography evaluation of Carpentier-Edwards Standard and Carpentier-Edwards Magna aortic prosthetic valve: comparison of hemodynamic performance. Cardiovasc Ultrasound. 2011;9:37. doi:10.1186/1476-7120-9-37.
Nozohoor S, Nilsson J, Lührs C, Roijer A, Sjögren J. Influence of prosthesis–patient mismatch on diastolic heart failure after aortic valve replacement. Ann Thorac Surg. 2008;85:1310–7.
Ruzicka DJ, Hettich I, Hutter A, Bleiziffer S, Badiu CC, Bauernschmitt R, et al. The complete supraannular concept: in vivo hemodynamics of bovine and porcine aortic bioprostheses. Circulation. 2009;120:S139–45.
Maitland A, Hirsch GM, Pascoe EA. Hemodynamic performance of the St. Jude Medical Epic Supra aortic stented valve. J Heart Valve Dis. 2011;20:327–31.
Rahimtoola SH. The problem of valve prosthesis–patient mismatch. Circulation. 1978;58:20–4.
Cotoni DA, Palac RT, Dacey LJ, O’Rourke DJ. Defining patient–prosthesis mismatch and its effect on survival in patients with impaired ejection fraction. Ann Thorac Surg. 2011;91:692–9.
Vicchio M, Della Corte A, De Santo LS, De Feo M, Caianiello G, Scardone M, et al. Prosthesis–patient mismatch in the elderly: survival, ventricular mass regression and quality of life. Ann Thorac Surg. 2008;86:1791–7.
Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol. 2000;36:1131–41.
Permanyer E, Estigarribia AJ, Ysasi A, Herrero E, Semper O, Llorens R. St. Jude Medical Trifecta™ aortic valve perioperative performance in 200 patients. Interact Cardiovasc Thorac Surg. 2013;17:669–72.
Saxena P, Greason KL, Schaff HV. Early structural valve deterioration of the Trifecta aortic valve biological prosthesis: a word of caution. J Thorac Cardiovasc Surg. 2013. doi:10.1016/j.jtcvs.2013.07.053.
Conflict of interest
Hiroyuki Seo, Yasushi Tsutsumi, Osamu Monta, Satoshi Numata, Sachiko Yamazaki, Shohei Yoshida, Takaaki Samura, and Hirokazu Ohashi declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seo, H., Tsutsumi, Y., Monta, O. et al. Early outcomes and hemodynamics after implantation of the Trifecta aortic bioprosthesis. Gen Thorac Cardiovasc Surg 62, 422–427 (2014). https://doi.org/10.1007/s11748-013-0362-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-013-0362-x