Key result
The Trifecta bioprosthesis with externally mounted leaflets was associated with a significantly higher 8-year cumulative reoperation rate for valve failure compared to the Perimount bioprosthesis (16.9% vs. 3.8%, p<0.01).
Why the study?
The use of bioprostheses in SAVR has increased in younger patients, but comparative analyses of different types of bioprostheses focusing on long-term durability and survival were lacking.
Does the Trifecta bioprosthesis compared to the Perimount bioprosthesis affect long-term durability and survival in patients undergoing surgical aortic valve replacement?
Cohort (n=5,053)
No
Does the Trifecta bioprosthesis compared to the Perimount bioprosthesis affect long-term durability and survival in patients undergoing surgical aortic valve replacement?
Absolute Event Rate: 16.9% vs 3.8%
p-value: p=<0.01
The Trifecta bioprosthesis is associated with a significantly higher long-term reoperation rate due to valve failure compared to the Perimount bioprosthesis, despite similar survival rates.
Trifecta valves were associated with higher reoperation rates; leaves open durability questions for prospective trials before changing valve selection.
Objectives The use of bioprostheses in surgical aortic valve replacement (SAVR) has increased in younger patients. Comparative analysis of different types of bioprostheses is lacking. We aimed to compare two proprietary bioprostheses with different designs, i.e., internally and externally mounted leaflets, focusing on the long-term durability and survival. Methods We conducted a large single-center retrospective analysis of all consecutive patients who underwent SAVR with either Perimount™ or Trifecta™ bioprostheses between 2001 and 2019. The patient groups were further subdivided by age <65 and >65. Endpoints of the study were all-cause mortality and reoperation due to bioprosthetic valve failure (BVF). Results Selection criteria resulted in a total sample of 5,053 patients; 2,630 received a Perimount prosthesis (internally mounted leaflets) and 2,423 received a Trifecta prosthesis (externally mounted leaflets). The mean age at surgery was similar (69 ± 11 y, PM, and 68 ± 10 y, TF, p = 0.9), as was estimated survival at 8 years (76.1 ± 1.3%, PM, and 63.7 ± 1.9% TF; p=0.133). Patients in the Trifecta group had a significantly higher cumulative reoperation rate at 8 years compared to those in the Perimount group (16.9 ± 1.9% vs. 3.8 ± 0.4%; p < 0.01). This difference persisted across age groups (<65 y, 13.3% TF vs. 8.6% PM; >65 y, 12% TF vs. 7% PM). Conclusion Bioprostheses for SAVR with externally mounted leaflets (Trifecta) showed significantly higher long-term reoperation rates compared to those with internally mounted leaflets (Perimount), regardless of the patient's age at SAVR. Survival was similar with both bioprostheses.
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Lange et al. (2022) conducted a cohort in Surgical aortic valve replacement (n=5,053). Trifecta bioprosthesis vs. Perimount bioprosthesis was evaluated on Cumulative reoperation rate due to bioprosthetic valve failure at 8 years (p=<0.01). The Trifecta bioprosthesis with externally mounted leaflets was associated with a significantly higher 8-year cumulative reoperation rate for valve failure compared to the Perimount bioprosthesis (16.9% vs. 3.8%, p<0.01).
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