title: Hemodynamic performance during exercise of the new St. Jude Trifecta aortic bioprosthesis: results from a French multicenter study.
abstract: BACKGROUND
  Initial experience with the new St. Jude Trifecta pericardial aortic stented bioprosthesis shows an excellent resting hemodynamic profile. Little is known about changes in the hemodynamic profile of the Trifecta valve during exercise.
  
  
  METHODS
  Between February 2011 and November 2012, 85 patients (49 men; mean age, 76 ± 7 years) with severe symptomatic aortic stenosis who underwent aortic valve replacement with the Trifecta bioprosthesis at three centers in France (Amiens, Rennes, and Angers) underwent quantitative Doppler echocardiographic at rest, during low-level exercise (25 W), and during peak exercise (68 ± 21 W), 6 months after aortic valve replacement.
  
  
  RESULTS
  Mean peak transvalvular aortic velocity, mean transvalvular gradient, and mean left ventricular ejection fraction for all valve sizes were 211 ± 35 cm/sec, 10 ± 3 mm Hg, and 62 ± 10% at rest; 237 ± 48 cm/sec, 13 ± 4 mm Hg, and 64 ± 10% during low-level exercise; and 248 ± 70 cm/sec, 15 ± 5 mm Hg, and 67 ± 10% during peak exercise, respectively. Mean effective orifice area was 1.84 ± 0.42 cm(2) at rest, 1.86 ± 0.84 cm(2) (P = .92) during low-level exercise, and 1.95 ± 0.62 cm(2) (P = .49) during peak exercise. The prevalence of prosthesis-patient mismatch was low in the overall series (23%) and increased to 30% for the smallest valve sizes (19 and 21 mm).
  
  
  CONCLUSIONS
  The new Trifecta bioprosthesis provides an excellent hemodynamic profile both at rest and during exercise. This type of valve could be an appropriate choice in patients with small aortic annular diameters, to avoid prosthesis-patient mismatch.
authors.affiliation: Department of Cardiology and INSERM and ERI-12, University Hospital, Amiens, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Levy
authors.affiliation: CIC-IT U 804, CHU Rennes, Université Rennes 1, Rennes, France; Service de Cardiologie, CHU Rennes, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: Université Angers, Laboratoire Protection et Remodelage du Myocarde, CHU Angers, Service de Cardiologie, Angers, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Bière
authors.affiliation: Department of Cardiology and INSERM and ERI-12, University Hospital, Amiens, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Szymanski
authors.affiliation: Department of Cardiology and INSERM and ERI-12, University Hospital, Amiens, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Remadi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: Université Angers, Laboratoire Protection et Remodelage du Myocarde, CHU Angers, Service de Cardiologie, Angers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fouquet
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Department of Cardiology and INSERM and ERI-12, University Hospital, Amiens, France. Electronic address: tribouilloy.christophe@chu-amiens.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology*; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D017755:Prosthesis Fitting
keywords: Bioprosthesis; Echocardiography; Exercise