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International Society For Minimally Invasive Cardiothoracic Surgery

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Trifecta-AVR Versus S3-TAVI In Hemodynamic Status
Ryoji Kinoshita, Susumu Manabe, Daiki Hirayama, Norihisa Yuge, Masahiro Oonuki, Kazunobu Hirooka.
Tsuchiura Kyodo General Hospital, Tsuchiura city, Ibaraki, Japan.

Background: Clinical studies comparing transcatheter aortic valve implantations (TAVI) with aortic valve replacements (AVR) have shown better hemodynamics with TAVI. However, these studies included older-generation biological valves in AVR group, so advances in biological valves have not been considered. The Trifecta is a next-generation valve with excellent hemodynamics and a large effective orifice area (EOA), but few studies have compared Trifecta AVR versus TAVI. Method: The subjects were 92 cases of Trifecta AVR (Group T) and 71 cases of Sapien 3 TAVI (Group S) who experienced severe AS between April 2013 and October 2019. Transthoracic echocardiograms (TTE) were performed immediately after the operation and 1-year follow-up period.Results: Group T and Group S differed in age, male sex and BSA. Pre-operative TTEs showed no differences between the groups for the state of the left ventricle. The valve sizes were 19 mm (38), 21 mm (35), 23 mm (18), and 25mm (1) in Group T and 20 mm (8), 23 mm (44), 26 mm (16), and 29mm (3) in Group S. The postoperative TTE results showed no differences in aortic valve maximum velocity (maxV) (2.3 vs. 2.4 m/sec), mean pressure gradient (meanPG) (12.1 vs. 12.9 mmHg), or above 20 mmHg meanPG (8/92 vs. 6/71). EOA did not differ, and the EOA for each size was 1.44 cm2 (19 mm), 1.73 cm2 (21 mm), and 1.79 cm2 (23mm) for Group T and 1.53 cm2 (23 mm) and 1.71 cm2 (26 mm) for Group S. Group T had 2 cases of mild periventricular leakage (PVL), while Group S had 45 trivial cases, 18 mild cases, and 4 moderate cases. Group T had significantly lower LVMI values (134.9 vs. 148.6 g/m2). The 1-year follow-up TTEs showed no significant differences in maxV (2.6 vs. 2.4 m/sec), meanPG (14.3 vs. 12.6 mmHg), or EOA (1.54 vs. 1.42 cm2). The LVMI reduction rate was higher in Group T (30.6% vs. 17.7%).Conclusion: The Trifecta and Sapien 3 valves had similar functionality when appropriately sized for the aortic annular diameter. However, PVL did not occur with AVR, and the AVR gave a superior reduction rate for the LVMI in follow-up period. Therefore, AVR using the Trifecta gave superior results to TAVI using the Sapien 3 from the perspective of valve functionality.


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