Clinical outcome and hemodynamic performance of St. Jude Trifecta aortic prosthesis: short-term follow-up and risk factors analysis

Abstract

Background: We retrospectively analysed the short-term outcome of the third-generation St. Jude Trifecta aortic prosthesis. Methods: Between December 2014 and December 2017, 177 patients (mean age 75.1±6.8 years, 95 males, 82 females) underwent aortic valve replacement with a St. Jude Trifecta aortic prosthesis and were followed up to 27±9 months. Preoperatively 92 patients (52.0%) were in NYHA class III-IV, EuroSCORE II was 3.2%±2.1%. Results: Trifecta sizes implanted were 19 mm (n=46) (26%), 21 mm (n=69) (39%), 23 mm (n=46) (26%), 25 mm (n=16) (9%). Concomitant coronary artery bypass grafting was performed in 60 patients (34.0%).Operative mortality was 3.4% (1.7% for isolated aortic valve replacement versus 6.7% for combined aortic valve replacement and coronary artery bypass grafting) (P=0.084). The only independent predictor of mortality was the need for the mechanical ventilation greater than 24 hours (P=0.037); recently occurring myocardial infarction was risk factor for mortality at the univariate analysis only (P=0.013). Three-year survival was 84%±6%, freedom from cardiac death 98%±1%, freedom from prosthetic endocarditis 97%±1%. No thromboembolisms or structural valve degeneration were observed. Patient-prosthesis mismatch (PPM) was absent in 126 patients (71.2%), mild-to-moderate in 32 (18.1%), moderate in 19 (10.7%), severe in no any patient. Follow-up echocardiography showed an average mean and peak transaortic valve gradients reduction more than 70% in comparison with preoperative value (P<0.0001), and a significant regression of left ventricular hypertrophy (P<0.0001). Moderate PPM did not negatively affect survival. Concomitant severe coronary artery disease was found as an independent predictor of reduced survival (72%±12% versus 86%±6%) (P=0.015). Conclusions: Trifecta aortic prosthesis seems to provide very favourable clinical outcome and hemodynamic performance. At three years, survival was negatively affected by severe coronary artery disease detected at the time of operation. During short-term follow-up, no early structural valve degeneration was been observed. Due to low incidence of PPM and low peak and mean trans-prosthetic aortic valve gradients, third generation Trifecta aortic prosthesis should be considered as one of the best options in the setting of the aortic valve replacement surgery. However, a long-term follow-up is mandatory to confirm the early promising data.

Early outcomes of patient-prosthesis mismatch following aortic valve replacement

“…Several studies presented favourable hemodynamics with St. Jude Trifecta in the AV position and considered it as the best option for AVR surgery. 28,29 Moreover, resting and exercise hemodynamics of the stented St. Jude Trifecta were similar to that of the stentless Medtronic Freestyle valve. 30 In a systematic review and meta-analysis by Phan et al, 31 attention was focused on the favourable mean gradient and EOA of this valve.…”

Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement

“…This promising performance has increased its approval, with a resultant popularity in usage. More large studies have also proved comparable or slightly lower rates of mortality and congestive heart failure, supporting the consensus surrounding the Trifecta [9,[12][13][14]. However, a Trifecta mid-term data analysis reports contradictory outcomes.…”

Early Hemodynamics after Aortic Valve Replacement

“…We speculate that the low PPM rate might be related to the excellent hemodynamic conditions afforded by the widely-used St Jude Trifecta valve, which was used in more than 70% of the patients. Several studies have suggested that the St Jude Trifecta valve shows favorable hemodynamics and is the best option for the aortic valve position [9,22,23]. In a systematic review and meta-analysis by Phan et al, particular attention was paid to the favorable mean gradient and EOA obtained with the Trifecta valve [24].…”