Midterm Haemodynamic Performance Of The St. Jude Medical Trifecta Valve In The Small Aortic Annulus.
Benjamin Adams, Jacob Chacko, Joy Edlin, Shirish Ambekar, John Yap, Kulvinder Lall.
Barts Heart Centre, London, United Kingdom.
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 hemodynamics. The aim of this prospective study was to evaluate the midterm hemodynamic performance of the Trifecta valve in patients with a small aortic annulus (Sizes 19mm & 21mm).
METHODS: One hundred and forty two consecutive patients undergoing aortic valve replacement using the St. Jude Medical Trifecta valve (Sizes 19mm & 21mm) at a single UK centre over a thirty-eight month period were included in this study. Patients undergoing concomitant cardiac procedures were included. Assessment of hemodynamic function was carried out using transthoracic echocardiography pre-operatively and at follow-up, as well as trans-esophageal echocardiography intra-operatively.
RESULTS: The study population consisted of 142 patients. Mean age was 78.7±10.4 years. Implanted valve sizes were 19mm (n=26) and 21mm (n=116). Subgroups mean post-operative pressure gradients were 11.4±3.6mmHg, 10.7±6.3mmHg 19mm & 21mm cohorts respectively. Overall mean post-operative left ventricular ejection fraction was 53.2±9.8%.
CONCLUSIONS: Clinicians have traditionally been reluctant to insert 19 and 21mm valves due to patient prosthesis mismatch and have resorted to aortic root enlargement surgery with associated increase in risk. Our experience demonstrate excellent haemodynamic performance of the Trifecta bioprosthetic valve in the small aortic annulus. Should longer-term results continue to show persistently low gradients in the smaller annulus, clinicians should carefully consider the necessity for aortic root enlargement surgery.
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