title: Comprehensive hemodynamic comparison and frequency of patient-prosthesis mismatch between the St. Jude Medical Trifecta and Epic Bioprosthetic aortic valves.
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 cm(2)/m(2), 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.
authors.affiliation: Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Ajay
authors.initials: A
authors.lastname: Yadlapati
authors.affiliation: Department of Medicine, Division of Cardiology, University of California Irvine, Irvine, California.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Diep
authors.affiliation: Long Beach Memorial Medical Center, Heart & Vascular Institute, Long Beach, California.
authors.forename: MaryJo
authors.initials: M
authors.lastname: Barnes
authors.affiliation: Department of Medicine, Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Tristan
authors.initials: T
authors.lastname: Grogan
authors.affiliation: Long Beach Memorial Medical Center, Heart & Vascular Institute, Long Beach, California.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bethencourt
authors.affiliation: Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: gvorobiof@mednet.ucla.edu.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Vorobiof
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D057234:Preoperative Period; D011474:Prosthesis Design; D017755:Prosthesis Fitting
keywords: Aortic valve replacement; Epic; Patient-prosthesis mismatch; Performance; Pericardial tissue bioprosthesis; Trifecta