Key result
Postoperative patient-prosthesis mismatch significantly increased the risk of early structural valve deterioration after aortic valve replacement with the Trifecta bioprosthesis (HR 7.73).
Why the study?
Several studies have reported high rates of structural valve deterioration in Trifecta valves, prompting an analysis of midterm results and risk factors for early deterioration.
Does patient-prosthesis mismatch increase the risk of early structural valve deterioration in patients undergoing aortic valve replacement with the Trifecta bioprosthesis?
Cohort (n=110)
No
Does patient-prosthesis mismatch increase the risk of early structural valve deterioration in patients undergoing aortic valve replacement with the Trifecta bioprosthesis?
Patient-prosthesis mismatch is a significant risk factor for early structural valve deterioration following aortic valve replacement with the Trifecta bioprosthesis, frequently presenting as noncoronary cusp tears.
Answers are grounded in this paper and cite their sources.
May warrant closer SVD surveillance after Trifecta implantation; extends prior reports but leaves open need for prospective validation.
BACKGROUND: Several studies have reported high rates of structural valve deterioration (SVD) in the Trifecta valves. Herein, we analyzed the midterm results of the Trifecta valve and risk factors for early SVD. METHODS: We retrospectively reviewed the records of 110 patients who had undergone Trifecta implantation between January 2012 and December 2017. RESULTS: We encountered seven cases of Trifecta valve failure. We performed a redo aortic valve replacement in five patients and a transcatheter aortic valve replacement in two patients. The SVD rate was 4.8% at 5 years and 6.6% at 7 years. The mean pressure gradient and peak velocity on the first postoperative echocardiogram in patients with SVD were higher than those in patients without SVD. The SVD rates with and without patient-prosthesis mismatch (PPM) were 2.8% and 12.6% at 5 years and 2.8% and 20.0% at 7 years. PPM is a risk factor for SVD. Noncoronary cusp tears were observed in all patients who had undergone redo surgery. CONCLUSIONS: The most common cause of SVD was noncoronary cusp tear. Patients with PPM are at high risk of developing SVD.
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Wakami et al. (2022) conducted a cohort in Aortic valve replacement with Trifecta bioprosthesis (n=110). Postoperative patient-prosthesis mismatch (PPM) vs. No patient-prosthesis mismatch was evaluated on Structural valve deterioration (SVD) (HR 7.73, 95% CI 1.46-41.0, p=0.02). Postoperative patient-prosthesis mismatch significantly increased the risk of early structural valve deterioration after aortic valve replacement with the Trifecta bioprosthesis (HR 7.73).
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