Longterm Results After Minimal Invasive Trifecta Aortic Valve Bioprothesis Implantation
Sven Lehmann1, Jens Garbade1, Anna Meyer1, Khalil Jawad1, Stefan Feder1, Ricardo Spampinato Torcivia1, Alexandro Hoyer1, Maya Dieterlen1, Anna Funkat2, Michael Borger1.
1Heartcenter Leipzig, Leipzig, Germany, 2Leipzig Heartinsitut, Leipzig, Germany.
Background: The St. Jude Medical Trifecta aortic valve prothesis is a new designed stented high performance tri-leaflet pericardial valve. The aim of the study was to evaluate the clinical outcome, 30 day- and longterm follow up in patients undergoing minimal invasive aortic valve replacement (MIC-AVR) with the Trifecta and Trifecta GT bioprothesis at our high volume tertiary care center.
Methods: We analyzed all patients undergoing MIC-AVR with the Trifecta or Trifecta GT bioprothesis (n=230; 53.5% male) between November 2007 and September 2017 at our institution. Mean follow-up was 4.2±2.6 years (range 0 to 10 years) and was complete in 100%.
Results: Patients age was 73.8±6.4 years, Ejection Fraction was 61±10% and logEuroscore 7.5±6.5. 1 patient (0.4%) present preoperative a endocarditis and also 1 patient (0.4%) had a typ a dissection at admission. 3 patients (1.3%) had a prior cardiac surgery. From all 230 patients 43 patients (18.7%) need an additional myektomie, 14 patients (6.1%) a replacement of the ascendens aorta and one patient (0.4%) an aortic arch replacement. Mean crossclamp time was 60.4±20.2 minutes and mean cardiopulmonary bypass time was 80.8±27.3 minutes. One patient (0.4%) need a IABP and a ECMO-therapy. A bleeding complication had 5.2% (n=12) from our patients. All patients need 3.1±4.6 red blood cell packs and 1.5±4.7 fresh frozen plasma. An postoperative symptomatic transitory psychotic syndrome had 11.7% (n=27%) and 1.7% (n=7) had a new stroke postoperative. A postoperative gastrointestinal complication had 7.8% (n=18) from these patients. 30-day survival rate was 95.6±1.3%, 90.4±2.2% after 5 years and 77.0±1.9% after 8 years. In patients with isolated AVR survival rate was 89.8±1.4% (30d), 81.1±1.8% after 5 years and 75.7±2.7% after 8 years. Freedom from reoperation at AVR was 97.1±0.5% after 5 years and 84.5±3.5% after 8 years. Freedom from endocarditis was 99.1±0.7 after 1 years and 96.4±1.5 after 5 and 8 years. Freedom from SVD was 100% after 5 years and 98.7±1.3% after 8 years.
Conclusion: MIC-AVR for using the Trifecta or Trifecta GT valve bioprothesis resulted in good clinical outcome with reasonable results in short- and long-term follow-up.
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