Early haemodynamic performance of a latest generation supra-annular aortic bioprosthesis: Experience from a large single-centre series

Objectives: The St Jude Medical (SJM) Trifecta bioprosthesis is a recently introduced stented trileaflet pericardial valve designed forsupra-annular replacement of the aortic valve (AVR). We sought to evaluate the short-term clinical outcome and haemodynamic performanceof the Trifecta valve after AVR.Methods: A total of 837 patients with severe symptomatic aortic valve stenosis or regurgitation underwent AVR with the SJM Trifectaaortic valve prosthesis between January 2009 and March 2013. All intra- and postoperative data were collected prospectively. At discharge,transthoracic echocardiography was performed. A complete set of echocardiographic data was available in 723 patients.RESULTS: Adjusted mean systolic pressure gradients (MPGs) for valve sizes 19 (n = 37/4.4%), 21 (n = 192/22.9%), 23 (n = 263/31.4%), 25 (n = 202/24.1%), 27 (n = 100/11.9%) and 29 mm (n = 42/5.0%) were 8.6 ± 1.1, 8.7 ± 0.4, 7.2 ± 0.3, 6.2 ± 0.3, 5.6 ± 0.3 and 3.9 ± 0.4 mmHg, respectively.Mean effective orifice area (EOA) for valve sizes 19, 21, 23, 25, 27 and 29 mm were 1.5 ± 0.09, 1.6 ± 0.04, 1.9 ± 0.03, 2.0 ± 0.03, 2.2 ± 0.05 and2.7 ± 0.01 cm2, respectively. No patient-prosthesis mismatch (PPM) was seen in 71.3% of patients (EOAI >0.85 cm2/m2). Moderate mismatch(EOAI 0.65-0.85 cm2/m2) was observed in 23.9% of patients, whereas severe PPM (EOAI <0.65 cm2/m2) occurred in 4.4% of patients. No malfunctionof the prosthesis, endocarditis, valve thrombosis or relevant aortic regurgitation necessitating surgical revision was observed until discharge.Conclusions: The SJM Trifecta valve reveals an excellent early haemodynamic performance with low residual MPGs and a low incidence ofPPM. Studies with longitudinal clinical and echocardiographic assessments with longer term follow-up evaluation including a comparison withother contemporary bioprostheses are needed.