title: Early in-vivo hemodynamic comparison of supra-annular aortic bioprostheses: Trifecta versus Perimount Magna Ease.
abstract: OBJECTIVE
  The study aim was to compare early postoperative hemodynamic gradients after supra-annular implantation of the Trifecta and Perimount Magna Ease aortic bioprostheses.
  
  
  METHODS
  Between January 2010 and December 2011, a total of 235 patients (105 males, 130 females; mean age at surgery 73.8 +/- 10.2 years) underwent supra-annular aortic valve replacement (AVR), with or without concomitant procedures. The patients were divided into 2 groups receiving either the Perimount Magna Ease (n = 117) or Trifecta (n = 118). Concomitant procedures were performed in 133 patients (56.6%), and 25 procedures (10.6%) were redos. Patients with postoperative severe left ventricular dysfunction and moderate to severe mitral regurgitation were excluded. Gradients were calculated pre-discharge using transthoracic echocardiography. Effective orifice area calculations were not performed. Data were collected retrospectively from hospital databases and analyzed using SPSS 17.
  
  
  RESULTS
  Both groups compared well for 14 variables. Group A had a higher number of redo operations and the patients were younger. Postoperative peak and mean gradients (in mmHg) for the Magna Ease group versus Trifecta group were: 19 mm valves, 33.5 +/- 16 versus 24.7 +/- 10 (p = 0.11) and 17.4 +/- 6.5 versus 12.7 +/- 4.4 (p = 0.05); 21 mm, 27.2 +/- 9.1 versus 21.8 +/- 7.2 (p = 0.001) and 13.8 +/- 4.7 versus 10.7 +/- 3.4 (p = 0.001); 23 mm, 25.6 +/- 7.8 versus 20.1 +/- 7.9 (p = 0.005) and 13 +/- 4 versus 10.1 +/- 4.3 (p = 0.002); 25 mm, 22.3 +/- 7.8 versus 15.6 +/- 5.1 (p = 0.01) and 12.8 +/- 4.1 versus 8 +/- 2.8 (p = 0.02). The overall mortality was 3.4%. The median hospital stay was nine days in both groups (p = 0.13). Mortality (p = 0.5), and incidences of perioperative stroke (p = 0.45), postoperative new-onset atrial fibrillation (p = 0.26) and permanent pacemaker implantation (p = 0.8) were similar in both groups.
  
  
  CONCLUSIONS
  Early postoperative gradients were significantly lower in patients receiving Trifecta valves, although the long-term clinical outcome and durability of the valve will require further evaluation.
authors.forename: Amit
authors.initials: A
authors.lastname: Modi
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pousios
authors.forename: Syed
authors.initials: S
authors.lastname: Sadeque
authors.forename: Theodore
authors.initials: T
authors.lastname: Velissaris
authors.forename: Clifford
authors.initials: C
authors.lastname: Barlow
authors.forename: Steven
authors.initials: S
authors.lastname: Livesey
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Tsang
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D016896:Treatment Outcome