Key result
19-mm Trifecta valve linked to lower mean pressure gradients and larger orifice areas vs conventional valves.
Why the study?
The haemodynamics of 19-mm bioprostheses in patients with a small aortic annulus have been reported in only a small number of patients, and the novel Trifecta valve aims to improve effective orifice area and prevent prosthesis-patient mismatch.
Does the 19-mm Trifecta bioprosthetic valve improve early haemodynamics compared to conventional 19-mm valves in patients undergoing aortic valve replacement for a small aortic annulus?
Cohort (n=128)
No
Does the 19-mm Trifecta bioprosthetic valve improve early haemodynamics compared to conventional 19-mm valves in patients undergoing aortic valve replacement for a small aortic annulus?
p-value: p=<0.001
The 19-mm Trifecta bioprosthesis provides superior early haemodynamics and prevents prosthesis-patient mismatch compared to conventional 19-mm valves in patients with a small aortic annulus.
May support Trifecta in small annuli for better early hemodynamics; leaves open long-term outcomes and needs RCT confirmation.
OBJECTIVES: A potential problem in aortic valve replacement (AVR) for patients with a small aortic annulus is prosthesis-patient mismatch (PPM). Although larger size prostheses have been well studied, the haemodynamics of 19-mm bioprostheses has been reported in only a small number of patients. The Trifecta valve is a novel bioprosthesis and its unique design is conceived to increase effective orifice area (EOA) and prevent PPM. This study aims at comparing the early haemodynamics of the new Trifecta valve with that of other conventional 19-mm valves. METHODS: We retrospectively evaluated 128 consecutive patients who underwent AVR with 19-mm bioprosthesis (39 Trifecta valve, 67 Magna Ease valve and 22 Mosaic Ultra valve) at Saitama International Medical Center between April 2012 and December 2014. Haemodynamics was evaluated by transthoracic echocardiography at 1 month after discharge and at 1-year follow-up. RESULTS: The average body surface area of all patients was 1.37 m(2). There was no difference in postoperative clinical outcomes between the three groups. Among the three groups, the mean pressure gradient (MPG) was the smallest (10.6 ± 4.3 mmHg, P < 0.001) and the EOA was the largest (1.63 ± 0.36 cm(2), P < 0.001) in the Trifecta group at 1 month after discharge. In the Trifecta group, PPM was not observed (P < 0.001), the MPG was the smallest (12.8 ± 3.6 mmHg, P < 0.001) and the EOA was the largest (1.50 ± 0.30 cm(2), P < 0.001) at the 1-year follow-up. CONCLUSIONS: The new 19-mm Trifecta valve showed favourable early haemodynamics compared with the conventional valves and may be useful for preventing PPM in patients with a small aortic annulus.
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Domoto et al. (2015) conducted a cohort in Small aortic annulus requiring aortic valve replacement (n=128). 19-mm Trifecta valve vs. Magna Ease and Mosaic Ultra 19-mm valves was evaluated on Mean pressure gradient at 1 month after discharge (p=<0.001). The 19-mm Trifecta valve showed a lower mean pressure gradient (10.6 ± 4.3 mmHg, P<0.001) and larger effective orifice area at 1 month compared to conventional 19-mm valves.
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