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OBJECTIVE: The St. Jude Medical Trifecta aortic supra-annular bioprosthesis is regarded as the next generation in pericardial stented tissue valves. The unique design of tissue leaflets attached to the exterior of the valve stent provides unrivalled in-vivo mean gradients and haemodynamics. The aim of this prospective study was to evaluate midterm haemodynamic performance.
METHODS: One hundred and seventy two consecutive patients undergoing aortic valve replacement using the St. Jude Medical Trifecta valve at a single UK centre over a 48-month period were included in this study. Both patients undergoing minimally invasive aortic valve replacement and those undergoing conventional aortic valve replacement were included. Patients undergoing concomitant cardiac procedures were included. All implanted valves were 19, 21, 23, 25, 27 & 29 mm in size. Assessment of haemodynamic function was carried out using transthoracic echocardiography pre-operatively and at follow-up, as well as transoesophageal echocardiography intra-operatively.
RESULTS: The study population consisted of 172 patients (105 male, 67 female). Mean age was 71.63±11.45 years. Implanted valve sizes were 19mm (n=12), 21mm (n=49), 23mm (n=72), 25mm (n=30), 27mm (n=8) and 29mm (n=1). Overall mean post-operative pressure gradients were 9.26±4.1mmHg (mean) and 17.7±7.6mmHg (peak). Subgroups mean post-operative pressure gradients were 11.1±3.4mmHg, 10.6±5.3mmHg, 9.1±3.4mmHg, 8.6±4.3mm, Hg6.2±2.7mmHg, 6.86±0mmHg, for the 19, 21, 23, 25,27 and 29mm cohort respectively. Overall mean post-operative left ventricular ejection fraction was 55.6±10.1%. Overall mean effective orifice area was 1.66±0.49cm2.
CONCLUSIONS: These results of our experience demonstrate excellent haemodynamic performance of the Trifecta bioprosthetic valve.