Abstract 17968: The New St. Jude TrifectaTM Versus Carpentier-Edwards Perimount MagnaTM and Magna EaseTM Aortic Bioprosthesis: Is There a Hemodynamic Superiority?
Background: The TrifectaTM valve is a new bovine pericardial aortic bioprosthesis designed for supra-annular aortic valve replacement (AVR). We compared the hemodynamic performance of the TrifectaTM versus the Perimount-MagnaTM and Magna-EaseTM valve in a non-randomized, observational, single-center study.
Methods: A total of 346 consecutive patients with aortic valve disease underwent AVR between 01/2003 and 11/2011 by either using the TrifectaTM (Group 1;n=121) or the Perimount-MagnaTM (Group 2;n=126) and Magna EaseTM bioprosthesis (Group 3;n=99). Clinical and hemodynamic data were prospectively recorded and compared between groups. Hemodynamic performance was evaluated by transthoracic echocardiography including peak and transvalvular aortic mean pressure gradients (MPG) and the aortic valve area (AVA) at baseline, discharge, and 6 months follow-up. A multivariate model of covariance analysis was constructed to further compare the primary study endpoints of MPG and AVA at 6 months follow-up.
Results: Unadjusted MPGs and AVAs for all valve sizes differed between groups (P<0.001) for the primary study endpoint at 6 months follow-up: MPGs and AVAs were 8.9±4.0mmHg and 2.1±0.5cm2 (Group 1), 10.0±4.4mmHg and 1.6±0.5cm2 (Group 2) and 11.4±3.1mmHg and 1.7±0.3cm2 (Group 3), respectively. Comparing the implanted valve sizes of 21mm, 23mm and 25mm, no differences in MPGs could be observed with 21mm and 23mm valves, only the 25mm Magna-EaseTM valve showed significant higher MPGs compared to Group 1 and 2 (11.0±3.2mmHg vs. 7.6±2.9mmHg and 7.9±2.2mmHg, P<0.001). After final adjustment by a multivariate model of covariance analysis, neither the MPGs (P=0.16) nor the AVAs (P=0.92) at 6 months postoperatively were influenced by the type of prosthesis.
Conclusions: The present observational study is the first to compare the new TrifectaTM valve with well-established supra-annular aortic valve bioprostheses from a hemodynamic perspective. Although mean pressure gradients and aortic valve areas seem to be advantageous at 6 months follow-up by the use of the new TrifectaTM valve, after multivariate covariance analysis, no influence of the prosthesis type on mean pressure gradients or aortic valve areas could be verified.
- © 2012 by American Heart Association, Inc.