Hemodynamic performance of Trifecta: single-center experience of 400 patients.
OBJECTIVE
To evaluate postoperative hemodynamic gradients and early outcomes of aortic valve replacement with the Trifecta bioprosthesis.


METHODS
Between 2011 and 2013, 400 patients underwent aortic valve replacement with a Trifecta bioprosthesis. Gradients were calculated by transthoracic echocardiography before discharge. Data were collected retrospectively; patients with postoperative severe left ventricular dysfunction or > mild mitral regurgitation were excluded.


RESULTS
The mean age was 75.9 ± 8.5 years, 197 (49.25%) patients were male, and 140 (35%) were >80-years old. Concomitant procedures were performed in 207 (51.75%) patients, and 30 (7.5%) had redo procedures. Supraannular aortoplasty with bovine pericardium was necessary in 25 (6.25%) cases. Hospital mortality was 2.75% (11 patients). Postoperative peak and mean gradients were 21.7 ± 9.3 and 11.1 ± 4.3 mm Hg for 19-mm valves (n = 29); 19.5 ± 7 and 9.7 ± 3.6 mm Hg for 21-mm valves (n = 158); 17.3 ± 6.6 and 8.7 ± 3.2 mm Hg for 23-mm valves (n = 134); 15.1 ± 6.1 and 7.8 ± 3.3 mm Hg for 25-mm valves (n = 56); 13.2 ± 3.7 and 6.9 ± 2.6 mm Hg for 27-mm valves (n = 11). Nine patients had trivial and one had mild transvalvular regurgitation. Mean follow-up was 1 ± 0.62 years; no patient required reoperation. Kaplan-Meier survival at 1 and 2 years was 94.3% ± 1.3% and 93.7% ± 1.4%.


CONCLUSIONS
Early postoperative gradients are low after Trifecta implantation. Significant transvalvular regurgitation was not observed, but the incidence of supraannular aortoplasty may be increased.
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK drmodiamit@hotmail.com.
Amit
A
Modi
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Mindaugas
M
Budra
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Szabolcs
S
Miskolczi
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Theodore
T
Velissaris
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Markku
M
Kaarne
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Clifford W
CW
Barlow
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Steven A
SA
Livesey
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Sunil K
SK
Ohri
Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, UK.
Geoffrey M
GM
Tsang
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D004739:England; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
Aortic valve insufficiency; aortic valve stenosis; bioprosthesis; heart valve prosthesis implantation; treatment outcome