Comprehensive Hemodynamic Comparison and Frequency of Patient-Prosthesis Mismatch between the St. Jude Medical Trifecta and Epic Bioprosthetic Aortic Valves - 25/05/14
Abstract |
Background |
Patient-prosthesis mismatch (PPM) has been reported with a wide range of bioprosthetic valves after aortic valve replacement (AVR) and has been associated with multiple adverse outcomes. The aim of this study was to test the hypothesis that a novel low-profile stented pericardial tissue bioprosthesis for AVR, the Trifecta aortic valve, would have superior hemodynamics, a lower incidence of PPM, and an improvement in clinical outcomes. Its hemodynamic performance was evaluated, and a comparison was performed with a traditional stented pericardial bioprosthesis (Epic) with respect to hemodynamics, PPM, and clinical events.
Methods |
One hundred twenty-four patients (mean age, 73.6 ± 11.0 years) underwent AVR. Prosthetic valve types used were Trifecta (n = 75 [60.5%]) and Epic (n = 49 [39.5%]). Intraoperative transesophageal echocardiography was used to evaluate hemodynamic variables before and after AVR.
Results |
Postoperative comparison of the Epic valve and the Trifecta valve revealed a lower mean pressure gradient (16.5 ± 6.7 vs 8.8 ± 3.4 mm Hg, P < .001), a lower peak gradient (33.3 ± 11.8 vs 19.4 ± 8.6 mm Hg, P < .001), and higher indexed effective orifice area (0.8 ± 0.2 vs 1.1 ± 0.4 cm2/m2, P < .001), favoring the Trifecta valve across several valve sizes. Severe PPM (6% vs 27%, P < .001) and valvular-related complications at follow-up (14.3% vs 36.7%, P = .005) were less frequent in the Trifecta group.
Conclusions |
The hemodynamic performance of the Trifecta valve is superior to that of the Epic valve across many conventional prosthesis sizes, and its implantation resulted in lower rates of severe PPM. These improvements were associated with lower valvular-related adverse events.
Le texte complet de cet article est disponible en PDF.Keywords : Performance, Pericardial tissue bioprosthesis, Aortic valve replacement, Trifecta, Epic, Patient-prosthesis mismatch
Abbreviations : AVR, EOA, EOAi, LV, LVOT, MG, PG, PPM, VTI
Plan
| Dr Bethencourt is a consultant for Intuitive Surgical (Sunnyvale, CA), St. Jude Medical (St. Paul, MN), Edwards Lifesciences (Irvine, CA), and Medtronic (Minneapolis, MN). Dr Vorobiof is a consultant for St. Jude Medical and Lantheus Medical Imaging (North Billerica, MA). |
Vol 27 - N° 6
P. 581-589 - juin 2014 Retour au numéro
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- Information for Readers
- Hemodynamic Performance during Exercise of the New St. Jude Trifecta Aortic Bioprosthesis: Results from a French Multicenter Study
- Franck Levy, Erwan Donal, Loïc Bière, Catherine Szymanski, Jean Paul Remadi, Erwan Flécher, Olivier Fouquet, Alain Leguerrier, Christophe Tribouilloy
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