Minimally Invasive Aortic Valve Surgery (MIAVR) Using St. Jude Medical Trifecta Aortic Bioprosthesis - An Assessment of Midterm Haemodynamic Function
David J. McCormack, Amir H. Sepehripour, Kulvinder S. Lall.
St. Bartholomew's Hospital, London, United Kingdom.
OBJECTIVE: The St. Jude Medical Trifecta valve represents the next generation of aortic supra-annular bioprosthesis. No literature currently exists on the ‘real-world’ performance of this valve. The aim of this prospective observational study was to evaluate the haemodynamic performance following implantation using a minimally invasive approach over midterm follow-up.
METHODS: Ninety-nine consecutive patients undergoing MIAVR (partial J sternotomy) using the St. Jude Medical Trifecta at a single UK centre were included in this study. Data was collected over a 24-month period. The subjects were evaluated pre-operatively, at end of operation (transoesophageal echo), and prior to discharge (transthoracic echo). During this experience with the St. Jude Medical Trifecta valve we have implanted 19, 21, 23, 25 and 27mm valves.
RESULTS: The mean subject age was 73.2 ±5.7 years. The mean post-operative pressure gradients were 8.78 ±3.6 mmHg, 8.13 ±2.3 mmHg, 8.26 ±3.5 mmHg, 7.01 ±3.8 mmHg, 7.27 ±2.7 mmHg, respectively, for valves sized 19mm (n=6), 21mm (n=26), 23mm (n=47), 25mm (n=16) and 27mm (n=4). On echocardiography assessment all valves were well seated. Moderate severe paravalvular leak was observed in one patient and mild-moderate leak in another. Otherwise there were only 14 patients with trivial regurgitation.
CONCLUSIONS: The results of our early experience with this new valve indicate that it offers excellent haemodynamic performance in the 19, 21, 23, 25 and 27mm sizes using a minimally invasive approach for implantation. The mean gradients compared favourably to other supra-annular aortic bioprostheses currently available.
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