Commentary: Early failure of the Trifecta GT bioprosthesis: Innovation is not always progress

Porterie, Jean; Kalavrouziotis, Dimitri; Mohammadi, Siamak

doi:10.1016/j.xjtc.2020.09.033

Cited by 1 publication

(3 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another proposed contributing factor has been the Trifecta's externally mounted design 12 . Whether this mounting design is more prone to shear stress from sinus of Valsalva currents or mechanical abrasion from the aortic wall is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Considerable research has demonstrated that lower postoperative gradients are associated with increased longevity, and the Trifecta valve's design reflects this focus with leaflets externally mounted to the stent frame to create the largest possible effective orifice area. 12 However, the innovation may not have solved the longevity issue the Trifecta valve was designed to address; a subtle improvement in hemodynamics may have come at the cost of early SVD. A recent analysis showed that the early superior hemodynamics is quickly reversed as the Trifecta begins to degenerate and gradients rise at a faster rate than alternative stented valves.…”

Section: Early Svdmentioning

confidence: 99%

“…17 Another proposed contributing factor has been the Trifecta's externally mounted design. 12 Whether this mounting design is more prone to shear stress from sinus of Valsalva currents or mechanical abrasion from the aortic wall is unclear. During our case series, a newer generation of the Trifecta valve (Trifecta GT) was initially claimed not to be associated with early SVD 18 ; however, a separate case series of the newer valve has been published showing leaflet detachment at the exact same location, which was confirmed by our analysis.…”

Section: Mechanism Of Failurementioning

confidence: 99%

See 2 more Smart Citations

Aortic valve biologic protheses: A cohort comparison of premature valve failure

Yount

Hawkins

Mehaffey

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background Recent reports suggest an increased rate of early structural valve degeneration (SVD) in the Trifecta bioprosthesis (Abbott Cardiovascular). We sought to compare the intermediate‐term outcomes of the Magna (Edwards Life Sciences) and Trifecta valves. Methods All surgical aortic valve replacements (SAVRs) with Trifecta or Magna/Magna Ease bioprostheses at an academic medical center were extracted from an institutional database. Patients who survived until after discharge (2011–2019) were included. The primary outcome was valve failure for any reason requiring reintervention or contributing to death, identified by reintervention or review of cause of death. Time to failure was estimated with Kaplan–Meier analysis and Cox Proportional Hazards Modeling. Results Out of 1444 patients, 521 (36%) underwent Trifecta and 923 (64%) underwent Magna implantation with a median follow‐up of 27.6 months. Trifecta patients had larger median valve size (25 vs. 23 mm, p < .001) and lower median gradient (8.0 vs. 10.9 mmHg, p < .001). Trifecta patients had higher 48‐month estimated failure rates (20.2 ± 7.6% vs. 2.6 ± 0.7%, p < .0001), with failure rates of 21.4 versus 9.2 failures per 1000 person‐years (p < .001). After risk‐adjustment, Trifecta patients had a 5.3 times hazard of failure (95% confidence interval: 2.78–12.34, p < .001) compared to Magna patients. Only Trifecta valves failed due to sudden aortic regurgitation, 8 out of 521 (1.5%). Conclusion Despite lower postoperative mean gradients, the Trifecta bioprosthesis may have an increased risk of intermediate‐term SVD. Further research is warranted to confirm the potential for sudden valve failure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Early Svdmentioning

confidence: 99%