title: Comparison of early haemodynamics of 19-mm aortic valve bioprostheses in patients with a small aortic annulus.
abstract: OBJECTIVE
  A potential problem in aortic valve replacement (AVR) for patients with a small aortic annulus is prosthesis-patient mismatch (PPM). Although larger size prostheses have been well studied, the haemodynamics of 19-mm bioprostheses has been reported in only a small number of patients. The Trifecta valve is a novel bioprosthesis and its unique design is conceived to increase effective orifice area (EOA) and prevent PPM. This study aims at comparing the early haemodynamics of the new Trifecta valve with that of other conventional 19-mm valves.
  
  
  METHODS
  We retrospectively evaluated 128 consecutive patients who underwent AVR with 19-mm bioprosthesis (39 Trifecta valve, 67 Magna Ease valve and 22 Mosaic Ultra valve) at Saitama International Medical Center between April 2012 and December 2014. Haemodynamics was evaluated by transthoracic echocardiography at 1 month after discharge and at 1-year follow-up.
  
  
  RESULTS
  The average body surface area of all patients was 1.37 m(2). There was no difference in postoperative clinical outcomes between the three groups. Among the three groups, the mean pressure gradient (MPG) was the smallest (10.6 ± 4.3 mmHg, P < 0.001) and the EOA was the largest (1.63 ± 0.36 cm(2), P < 0.001) in the Trifecta group at 1 month after discharge. In the Trifecta group, PPM was not observed (P < 0.001), the MPG was the smallest (12.8 ± 3.6 mmHg, P < 0.001) and the EOA was the largest (1.50 ± 0.30 cm(2), P < 0.001) at the 1-year follow-up.
  
  
  CONCLUSIONS
  The new 19-mm Trifecta valve showed favourable early haemodynamics compared with the conventional valves and may be useful for preventing PPM in patients with a small aortic annulus.
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan sdomoto@saitama-med.ac.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Domoto
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Niinami
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Uwabe
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koike
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Mimiko
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Morita
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kambe
authors.affiliation: Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iguchi
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors
keywords: Aortic valve replacement; Effective orifice area; Pressure gradient; Prosthesis-patient mismatch; Trifecta valve