Early surgical aortic bioprosthesis failure caused by cusp tear: A word of caution

Schaeffer, Thibault; Berdajs, Denis; Reuthebuch, Oliver

doi:10.1002/ccr3.3516

Cited by 8 publications

(9 citation statements)

References 20 publications

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“…The occurrence of sudden leaflets tear due to mechanical stress has been occasionally reported in several case reports and small series [ 13–15 ] as further reviewed by Schaeffer et al [ 16 ] and Kaneyuki et al [ 8 ]. In a large series of 1058 patients followed at the University of Michigan, sudden onset of aortic regurgitation—mostly secondary to a partial cusp tear along a sent post—was found in 55% of the cases of Trifecta failure [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Modes of failure of Trifecta aortic valve prosthesis

Malvindi

Kattach

Luthra

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Several concerns have been recently raised regarding the durability of Trifecta prostheses. Different mechanisms of early failure were reported. Our aim was to study in a large population the modes of failure of Trifecta valves. METHODS We conducted a retrospective analysis of patients who underwent surgical aortic valve replacement with a Trifecta prosthesis during the period 2010–2018. Details regarding the mode of failure and haemodynamic dysfunction were collected for patients who underwent reintervention for structural valve failure. The Kaplan–Meier method was used to calculate survival. Competing risk analysis was performed to calculate the cumulative risk of reintervention for structural valve failure. RESULTS The overall population comprises 1228 patients (1084 TF model and 144 TFGT model). Forty-four patients—mean patients’ age at the time of the first implant 69 (standard deviation: 12) years and 61% female—underwent reintervention for structural valve failure after a median time of 63 [44–74] months. The cumulative incidence of reintervention for structural valve failure was 0.16% (SE 0.11%), 1.77% (SE 0.38%) and 5.11% (SE 0.98%) at 1, 5 and 9 years, respectively. In 24/44 patients (55%), a leaflet tear with dehiscence at the commissure level was found intraoperatively or described by imaging assessment. The cumulative incidence of reintervention for failure due to leaflet(s) tear was 0.16% (SE 0.11%), 1.08% (SE 0.29%) and 3.03% (SE 0.88%) at 1, 5 and 9 years, respectively. CONCLUSIONS Leaflet(s) tear with dehiscence along the stent post was the main mode of early failure, up to 5 years, after Trifecta valves’ implantation.

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Section: Discussionmentioning

confidence: 99%

Modes of failure of Trifecta aortic valve prosthesis

Malvindi

Kattach

Luthra

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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“…In clinical settings, there have been reports of early Trifecta valve failures caused by cusp tears which lead to prosthetic valve AR. 4,16,17 On the other hand, Yongue et al 3 reported that the main mode of Trifecta valve failure was calcific SVD rather than prosthetic valve AR. Consequently, the mode that contributes to the valve failure remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…6 However, prosthetic valve AR occurs relatively early up to 3-5 years after implant in Trifecta patients. 3,16,17 Therefore, there was some time delay between those two events. Given this delay, we speculated that SVD had started with prosthetic valve AR, which was exacerbated by calcific SVD later with the development of leaflet thickening that can affect leaflet coaptation.…”

Section: Prosthetic Valve Ar and Calcific Svd Synergistically Contrib...mentioning

confidence: 99%

Trifecta versus Perimount Magna Ease aortic valves: Failure mechanisms

Suzuki

Ito

Suzuki

et al. 2022

Asian Cardiovasc Thorac Ann

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Background There are increasing reports of early externally mounted pericardial Trifecta bioprosthesis failure. We compared the hemodynamic performance of Trifecta and Carpentier–Edwards Perimount Magna Ease valves to determine the failure mechanism. Methods We retrospectively included 270 consecutive patients (age: 73.4 ± 8.2 years; 57.5% male; mean follow-up: 48.0 ± 20.3 months) who underwent aortic valve replacement from 2014 to 2021 at a single center and compared the Trifecta ( N = 137) and Carpentier–Edwards Perimount Magna Ease valve ( N = 133) patients. Results The prosthetic valve major aortic regurgitation incidence was higher for the Trifecta than that for the Carpentier–Edwards Perimount Magna Ease valve (6.3% vs. 0%, P < 0.009). Among the Trifecta failures, 33% developed structural valve deterioration, but all requiring redo aortic valve replacement developed major prosthetic valve aortic regurgitation. Freedom at 5 years from redo aortic valve replacement due to structural valve deterioration was significantly lower for Trifecta (89.4% vs. 100%, P = 0.003). The reoperation hazards were determined for Trifecta (vs. Carpentier–Edwards Perimount Magna Ease): 11.6 (1.47–90.9; P = 0.02), prosthetic valve aortic regurgitation: 2.38 (1.70–3.32; P < 0.01), structural valve deterioration: 20.82 (4.08–106.2; P < 0.01), 5-year mean transprosthetic pressure gradient: 1.14 per 1-point increase (1.03–1.24; P = 0.007), and urgent surgery: 10.1 (2.59–39.0; P = 0.001). The Cox regression analysis identified that prosthetic valve aortic regurgitation solely contributed to redo aortic valve replacement (hazard ratio: 2.38; confidence intervals: 1.70–3.32). Conclusions Significantly, more early failures occurred with the Trifecta valve than the Carpentier–Edwards Perimount Magna Ease valve but the Trifecta showed reasonable mean transprosthetic pressure gradient over time. Prosthetic valve aortic regurgitation and calcific structural valve deterioration synergistically contributed to Trifecta valve failure alternatively.

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“…The hemodynamic advantage of the Trifecta valve is reportedly due to the valve leaflets being mounted on the outside the sewing ring [12] , [13] . However, in the past few years, there have been a number of reports of Trifecta valve leaflet tears leading to early SVD [7] , [8] , [9] .…”

Section: Clinical Discussionmentioning

confidence: 99%

“…While the number of SAVR cases has been increasing for patients in their sixties due to the improvement of bioprosthetic valves, some early structural valve deterioration (SVD) in Trifecta valves has been reported [7] , [8] , [9] . Here, we report on our experience with a reoperation for early SVD in a Trifecta GT valve four years after the initial SAVR operation as well as our technique to remove the implanted valve.…”

Section: Introduction and Importancementioning

confidence: 99%

Redo aortic valve replacement due to early structural valve deterioration in a trifecta valve: A case report

Watanabe

Tokunaga

Maruno

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance While the number of SAVR cases has been increasing for patients below their sixties due to the improvement of bioprosthetic valves, some early structural valve deterioration (SVD) in Trifecta valves has been reported. Case presentation We present a case of a female who presented with sudden shortness of breath. Ultrasonography diagnosed SVD. We performed redo aortic valve replacement due to SVD in Trifecta valve. With our surgical technique we could remove the bioprosthetic valve easily. Clinical discussion We could easily remove the mounted prosthetic valve along with the titanium band. These cases may emerge with acute heart failure due to sudden massive aortic regurgitation, not like the gradual progression of stenosis due to calcification. Conclusion The postoperative course in Trifecta recipients must be followed carefully.

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Early surgical aortic bioprosthesis failure caused by cusp tear: A word of caution

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 8 publications

References 20 publications

Modes of failure of Trifecta aortic valve prosthesis

Modes of failure of Trifecta aortic valve prosthesis

Trifecta versus Perimount Magna Ease aortic valves: Failure mechanisms

Redo aortic valve replacement due to early structural valve deterioration in a trifecta valve: A case report

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