Abstract
Background Modern supraannular aortic xenografts offer a special design, thus providing maximized
opening area for improved hemodynamics. The aim of this study was a prospectively
randomized comparison of the Trifecta and the Perimount Magna Ease valves based on
metric annulus sizing.
Methods A total of 100 patients with aortic stenosis undergoing aortic valve replacement
(AVR) with or without concomitant procedures were prospectively included. After decalcification
of the annulus, stratified intraoperative randomization was performed. The diameter
of the aortic annulus was measured using metric Hegar dilators and randomization was
based on this metric annulus diameter. Exercise echocardiography was performed at
10-month follow-up.
Results Mean age was 69 years, with 36% female. Predominant implanted valve sizes were 23 mm
(39%) and 25 mm (32%). Unadjusted mean pressure gradient was significantly lower and
effective orifice area larger for the Trifecta group (10.8 ± 5 vs. 13.2 ± 4 mm Hg,
p = 0.02 and 1.93 ± 0.39 vs. 1.70 ± 0.30 cm2, p = 0.002) at discharge. In patients with small annuli, based on the metric annulus
size there were no significant differences in gradients or the orifice area. At exercise
echocardiography follow-up, there were no significant hemodynamic differences between
both prostheses.
Conclusions The Trifecta and the Perimount Magna Ease prostheses both show excellent hemodynamic
performance after AVR. In patients with larger annuli, the Trifecta valve seems to
be even superior to the Magna Ease, which may be advantageous in obese patients.
Keywords
aortic valve and root - echocardiography; all modalities - applications - heart valve
surgery - xenograft
