title: Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients.
abstract: OBJECTIVE
  Superior aortic valve hemodynamic performance can accelerate left ventricular mass regression and enhance survival and functional status after surgical aortic valve replacement. This can be achieved by rapid deployment aortic valve replacement using a subannular balloon-expandable stent frame, which functionally widens and reshapes the left ventricular outflow tract, to ensure a larger effective orifice area compared with conventional surgical valves. We report the intermediate-term follow-up data from a large series of patients enrolled in the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial.
  
  
  METHODS
  In a prospective, multicenter (6 European hospitals), single-arm study, 287 patients with aortic stenosis underwent rapid deployment aortic valve replacement using a stented trileaflet bovine pericardial bioprosthesis. Core laboratory echocardiography was performed at baseline, discharge, and 3 months, 1 year, and 3 years after rapid deployment aortic valve replacement.
  
  
  RESULTS
  The mean patient age was 75.7 ± 6.7 years (range, 45-93; 49.1% women). The mean aortic valve gradient significantly decreased from discharge to 3 years of follow-up. The mean effective orifice area remained stable from discharge to 3 years. At 1 year, the left ventricular mass index had decreased by 14% (P < .0001) and at 3 years by 16% (P < .0001) compared with at discharge. The prevalence of severe patient-prosthesis mismatch was 3% at discharge and remained stable during the follow-up period.
  
  
  CONCLUSIONS
  In a large series of elderly patients with symptomatic severe aortic stenosis, rapid deployment aortic valve replacement using a subannular balloon-expandable stent frame demonstrated excellent hemodynamic performance and significant left ventricular mass regression. With continued follow-up, future studies will establish whether these favorable structural changes correlate with improvement in long-term survival and functional status.
authors.affiliation: Medical University of Hannover, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Medical University of Cologne, Cologne, Germany. Electronic address: thorsten.wahlers@uk-koeln.de.
authors.forename: Thorsten C
authors.initials: TC
authors.lastname: Wahlers
authors.affiliation: Heart Center Leipzig, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Medical University of Hannover, Hannover, Germany.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Kocher
authors.affiliation: Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.affiliation: Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Roth
authors.affiliation: Heart Center Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: Heart Center Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Kempfert
authors.affiliation: University of Leipzig, Leipzig, Germany.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Dohmen
authors.affiliation: University of Munich, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.affiliation: Medical University of Cologne, Cologne, Germany.
authors.forename: Parwis
authors.initials: P
authors.lastname: Rahmanian
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.affiliation: Edwards Lifesciences LLC, Irvine, Calif.
authors.forename: Francis G
authors.initials: FG
authors.lastname: Duhay
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D005060:Europe; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling