Early hemodynamic outcome after implantation of the new Trifecta™ aortic valve prosthesis in comparison to established size-matched stented tissue valves

Objectives: The Trifecta™ valve is a pericardial aortic, supra-annular stented tissue valve with a tri-leaflet design. It has been reported to provide superior hemodynamic outcome compared with previous stented tissue valves, reaching the level of stentless prostheses.

Methods: In order to evaluate early hemodynamic outcome after implantation of the Trifecta™ valve a total cohort of 128 patients receiving elective or urgent aortic valve replacement (AVR) with a biological prosthesis in our institution was reviewed. Out of this cohort 64 patients received the Trifecta™ (TF) valve between January and December 2011. Postoperative valve performance was assessed on day 7 after surgery by means of echocardiography and compared with 64 consecutive size-matched Perimount™ (PM) stented prostheses (n = 64) implanted between January 2007 and January 2011 and representing a well -established tissue valve for routine AVR at our institution. Patients with a significantly depressed left ventricular performance (LVEF < 30%) were excluded from the study.

Results: The mean age of the 128 patients was 73 ± 8.4 years. Of the total cohort 24 patients received a 21 mm valve, with a mean postoperative gradient of 12.0 ± 5.3 mmHg for the “TF” group vs. 13.8 ± 5.7 mmHg for the “ PM” group (p = 0.61). 42 patients received a 23 mm valve (mean gradient 9.0 ± 3.2 mmHg “TF” vs. 15.0 ± 4.9 mmHg “PM”, p < 0.05), 50 patients received a 25 mm valve (mean gradient 8.3 ± 2.9 mmHg “TF” vs. 11.8 ± 4.2 mmHg “PM”, p < 0.05) and 12 patients received a 27 mm valve (mean gradient 6.2 ± 1.7 mmHg “TF” vs. 11.7 ± 4.2 mmHg “PM”, p < 0.05). No major valvular or paravalvular regurgitation, neither any other early prosthesis related complication and no perioperative death were recorded in the “TF” or the “EP” group, respectively.

Conclusion: The Trifecta™ aortic valve prosthesis offers excellent hemodynamic performance and the current study suggests superiority in comparison to established size-matched stented tissue valves. In fact, if proven significant in a larger, prospective analysis, the reported results are comparable to those achieved by technically more demanding stentless aortic valve prostheses.