Comprehensive Hemodynamic Comparison and Frequency of Patient Prosthesis Mismatch Between the St. Jude Medical Epic and Trifecta Bioprosthetic Aortic Valves

Yadlapati, Ajay; Barnes, Mary J.; Diep, Jimmy; Bethencourt, Daniel M.; Vorobiof, Gabriel

doi:10.1016/s0735-1097(13)61986-5

Cited by 5 publications

(8 citation statements)

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“…15 The overall incidence of severe PPM with Trifecta and Magna Ease is low and reported to be approximately 1% to 6%. 2,10,13,16,17 Although our study showed a small but statistically significant hemodynamic advantage of the Trifecta over Magna/Magna Ease, there were not enough data to systematically assess left ventricular (LV) mass regression or incidence of severe PPM. Rubens et al 7 has previously demonstrated improvements in LV mass regression with the Trifecta valve.…”

Section: Discussionmentioning

confidence: 87%

“…Numerous head-to-head comparisons have demonstrated the hemodynamic superiority of contemporary bioprostheses over older-generation models, manifesting with lower gradients, larger effective orifice areas (EOAs) and lower incidence of patient-prosthesis mismatch (PPM). [2][3][4] However, there is a paucity of comparative data between the different commercially available contemporary aortic bioprostheses. We performed a systematic review and meta-analysis to determine the early echocardiographic measures comparing two of the most commonly used bioprostheses: Magna/Manga Ease and Trifecta.…”

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confidence: 99%

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Magna Ease versus Trifecta Early Hemodynamics

Yanagawa

Tam

Hong

et al. 2018

Innovations�(Phila)

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Objective This meta-analysis compares the early echocardiographic outcomes of aortic valve replacement using the two most commonly implanted stented bioprostheses. Methods We searched MEDLINE and EMBASE databases until 2017 for studies comparing Magna or Magna Ease (Edwards Lifesciences, Irvine, CA USA) versus Trifecta (St Jude Medical, St. Paul, MN USA) aortic bioprosthetic valves. A random-effects meta-analysis was performed for the primary outcome of mean gradient on echocardiography and secondary outcomes of effective orifice area, indexed effective orifice area, and in-hospital mortality. Results There were two randomized controlled trial, three matched, and six unmatched retrospective observational studies with 2119 patients [median reported follow-up = 6 months (interquartile range = 6 to 12)]. The Magna/Magna Ease valve was associated with higher early mean gradient (mean difference = 4.09, 95% confidence interval = 3.48 to 4.69, P < 0.0001) and smaller effective orifice area (mean difference = 0.30, 95% confidence interval = −0.38 to −0.22, P < 0.0001). There were no differences in 30-day mortality between Magna/Magna Ease and Trifecta (relative risk = 1.01, 95% confidence interval = 0.41 to 2.50, P = 1.0). Conclusions Trifecta may offer a small hemodynamic advantage compared with the Magna/Magna Ease valve with no differences in early mortality. Long-term follow-up is required to determine whether these differences persist and translate into differences in clinical outcomes.

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Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

Magna Ease versus Trifecta Early Hemodynamics

Yanagawa

Tam

Hong

et al. 2018

Innovations�(Phila)

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“…9 It is also meant to increase EOA and hemodynamic performance with the pericardial leaflets mounted externally to the stent frame. 10 In addition, this valve has been reported to provide optimal function and durability in periods of high demand, such as during exercise, due to its inherent distensibility. 10 Furthermore, the anticalcification treatment has been suggested to remove up to 94% of phospholipids from leaflet tissue and has shown effectiveness at midterm follow-up in porcine bioprostheses.…”

Section: Discussionmentioning

confidence: 99%

“…10 In addition, this valve has been reported to provide optimal function and durability in periods of high demand, such as during exercise, due to its inherent distensibility. 10 Furthermore, the anticalcification treatment has been suggested to remove up to 94% of phospholipids from leaflet tissue and has shown effectiveness at midterm follow-up in porcine bioprostheses. 11 While current minimally invasive AVR surgery is associated with mortality and stroke rates that are comparable to those with conventional surgical AVR, mini-AVR is also associated with a lower risk of bleeding and use of perioperative blood products, shorter duration of ICU and hospital stay, reduced duration of assisted ventilation, and a greater improvement in the quality of life postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes of Isolated Aortic Valve Replacement Through Right Anterior Minithoracotomy Using the Latest-Generation Biological Prosthesis

Amirjamshidi

Vidovich

Goodman

et al. 2020

Innovations�(Phila)

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Objective The aim of this study is to evaluate early and intermediate outcomes and hemodynamics of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Methods We performed a single-center, retrospective, observational study including 175 individuals who underwent isolated minimally invasive aortic valve replacement with the latest-generation Trifecta valves through a right anterior minithoracotomy between January 2016 and January 2019. Exclusion criteria for follow-up echocardiographic study included concomitant procedures, conversion to median sternotomy, and nonsurvival during the index admission. Analyses addressed implantation safety, 30-day and intermediate-term survival and hemodynamic performance of the valves. Results Overall, patients were followed with duration ranging from 0.5 to 3 years. Early (<30 days) mortality occurred in 2 patients (1.1%), and there were 9 (5.1%) late (>30 days) deaths. Early thromboembolic events and postoperative bleeding requiring reoperation occurred at a rate of 4.0% ( n = 7) and 6.2% ( n = 11), respectively. Overall in 175 patients who met inclusion criteria for the follow-up echocardiography study, mean gradients across all valve sizes were 41.3 ± 14.9 (standard deviation) mm Hg preoperatively and remained low at 7.2 ± 3.9 mm Hg with mean effective orifice area of 1.8 ± 0.5 cm2 on the last follow-up echo. There was 1 case of infective prosthetic endocarditis, which did not require valve explant. There were no reoperations due to valve-related problems during the study period. Conclusions This is the largest series reporting on outcomes of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Our results demonstrate that this valve can be safely implanted via a minimally invasive approach with excellent early and intermediate outcomes and hemodynamic performance.

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“…In general, the hemodynamic performance of newer generations of prosthetic valves is better than older generations, and the supra-annular stented bioprosthesis has been proven to be superior to the annular ones, providing a larger iEOA. [ 43 44 ] The incidence of PPM with the newer generation of mechanical valves also appears to be lower, and they are well tolerated in patients with small annuli. [ 45 46 ] Superior hemodynamic performance of stentless bioprosthesis can be observed both at rest and during exercise.…”

Section: Preemptive Strategies and Ppmmentioning

confidence: 99%

Prosthesis-patient mismatch - what cardiac anesthesiologists need to know?

Subramaniam¹,

Nazarnia²

2017

Ann Card Anaesth

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Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.

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Comprehensive Hemodynamic Comparison and Frequency of Patient Prosthesis Mismatch Between the St. Jude Medical Epic and Trifecta Bioprosthetic Aortic Valves

Cited by 5 publications

References 0 publications

Magna Ease versus Trifecta Early Hemodynamics

Magna Ease versus Trifecta Early Hemodynamics

Early Outcomes of Isolated Aortic Valve Replacement Through Right Anterior Minithoracotomy Using the Latest-Generation Biological Prosthesis

Prosthesis-patient mismatch - what cardiac anesthesiologists need to know?

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