Is Trifecta safe for small valve size from mid-term outcome?

Background: Several studies have reported a high structural valve deterioration (SVD) rate for the Trifecta valve. We analyzed the midterm outcomes of the Trifecta valve and risk factors for early SVD.Methods: We retrospectively reviewed 110 patients who underwent Trifecta implantation between January 2012 and December 2017.Results: We encountered seven cases of Trifecta valve failure. We performed redo aortic valve replacements in five patients and transcatheter aortic valve replacements in two patients. The free rate of SVD was 96.1% at five years and 92.6% at seven years. The mean pressure gradient and peak velocity in the first postoperative echocardiogram in patients with SVD were higher than those in patients with SVD. The SVD-free rates of the 19 mm valve and other valves were 93% and 95.6% at five years and 89.6% vs. 95.6% at seven years, respectively. Although not statistically significant, the 19 mm valves tended to be SVD. Noncoronary cusp tears were seen in all patients who underwent a redo surgery.Conclusions: The most common cause of SVD was noncoronary cusp tear. Patients with a high postoperative mean pressure gradient are at a high risk of SVD. The small size of the Trifecta for a small annulus or Valsalva sinus may be a risk factor for early SVD.