title: Early haemodynamic performance of a latest generation supra-annular aortic bioprosthesis: experience from a large single-centre series.
abstract: OBJECTIVE
  The St Jude Medical (SJM) Trifecta bioprosthesis is a recently introduced stented trileaflet pericardial valve designed for supra-annular replacement of the aortic valve (AVR). We sought to evaluate the short-term clinical outcome and haemodynamic performance of the Trifecta valve after AVR.
  
  
  METHODS
  A total of 837 patients with severe symptomatic aortic valve stenosis or regurgitation underwent AVR with the SJM Trifecta aortic valve prosthesis between January 2009 and March 2013. All intra- and postoperative data were collected prospectively. At discharge, transthoracic echocardiography was performed. A complete set of echocardiographic data was available in 723 patients.
  
  
  RESULTS
  Adjusted mean systolic pressure gradients (MPGs) for valve sizes 19 (n = 37/4.4%), 21 (n = 192/22.9%), 23 (n = 263/31.4%), 25 (n = 202/24.1%), 27 (n = 100/11.9%) and 29 mm (n = 42/5.0%) were 8.6 ± 1.1, 8.7 ± 0.4, 7.2 ± 0.3, 6.2 ± 0.3, 5.6 ± 0.3 and 3.9 ± 0.4 mmHg, respectively. Mean effective orifice area (EOA) for valve sizes 19, 21, 23, 25, 27 and 29 mm were 1.5 ± 0.09, 1.6 ± 0.04, 1.9 ± 0.03, 2.0 ± 0.03, 2.2 ± 0.05 and 2.7 ± 0.01 cm(2), respectively. No patient-prosthesis mismatch (PPM) was seen in 71.3% of patients (EOAI >0.85 cm(2)/m(2)). Moderate mismatch (EOAI 0.65-0.85 cm(2)/m(2)) was observed in 23.9% of patients, whereas severe PPM (EOAI <0.65 cm(2)/m(2)) occurred in 4.4% of patients. No malfunction of the prosthesis, endocarditis, valve thrombosis or relevant aortic regurgitation necessitating surgical revision was observed until discharge.
  
  
  CONCLUSIONS
  The SJM Trifecta valve reveals an excellent early haemodynamic performance with low residual MPGs and a low incidence of PPM. Studies with longitudinal clinical and echocardiographic assessments with longer term follow-up evaluation including a comparison with other contemporary bioprostheses are needed.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany deutsch@dhm.mhn.de.
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Anatol
authors.initials: A
authors.lastname: Prinzing
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Fiegl
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wottke
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Catalin C
authors.initials: CC
authors.lastname: Badiu
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany DZHK (German Center for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Krane
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Gertrud
authors.initials: G
authors.lastname: Goppel
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Guenzinger
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany DZHK (German Center for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D016896:Treatment Outcome
keywords: Aortic valve replacement; Haemodynamics; Stented pericardial bioprosthesis; Trifecta valve