Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch

Abstract

The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient–prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient–prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient–prosthesis mismatch: OR = 0.5 (95% CI 0.3–0.9, p = 0.02). Both prostheses led to a similar risk of severe patient–prosthesis mismatch: OR = 0.9 (95% CI 0.3–2.8, p = 0.79). Both prostheses provide a very low risk of severe patient–prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch.

Aortic valve neocuspidization using autologous pericardium compared to surgical aortic valve replacement

“…In a large meta‐analysis on 40381 patients, Dayan et al found a proportional relationship between the severity of PPM and the overall mortality, 29 particularly in case of severe PPM with an EOAI < 0.65 cm 2 /m 2 18,29–31 . In the current study, the results for severe PPM after replacement with the St. Jude Trifecta bioprosthesis with 3.6% are in line with former research 22,25 . Notably, the AVNeo group did not significantly differ from SAVR in terms of incidence of severe mismatch (EOAI < 0.65 cm 2 /m 2 ) with four patients (3.8%) in the AVNeo group versus 14 patients (3.6%) in the SAVR ( p = .557).…”

“…Pirola et al observed MPG's of 7.5 mmHg ± 3.9 at 3 months after AVNeo 17 and Ngo et al reported on MPG's of 6.8 ± 1.4 mmHg at 1 week after AVNeo 21 . For the Trifecta bioprosthesis, similar results have been reported 22–27 . In a series of 480 patients, Raimundo et al reported on MPG's of 10.9 ± 4.1 mmHg and EOA of 2.0 ± 0.5 cm 2 , respectively 24 .…”

“…18,[29][30][31] In the current study, the results for severe PPM after replacement with the St. Jude Trifecta bioprosthesis with 3.6% are in line with former research. 22,25 Notably, the AVNeo group did not significantly differ from SAVR in terms of incidence of severe mismatch (EOAI < 0.65 cm 2 /m 2 ) with four patients (3.8%) in the AVNeo group versus 14 patients (3.6%) in the SAVR (p = .557).…”

“…21 For the Trifecta bioprosthesis, similar results have been reported. [22][23][24][25][26][27] In a series of 480 patients, Raimundo et al reported on MPG's of 10.9 ± 4.1 mmHg and EOA of 2.0 ± 0.5 cm 2 , respectively. 24 In a large multicenter study, Bavaria et al analyzed 1014 patients with a Trifecta bioprosthesis and reported on MPG's at discharge ranging from 9.3 to 4.1 mmHg and EOA's ranging from 1.58 to 2.50 cm 2 for valve sizes 19 to 29 mm, respectively.…”

Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

“…Compared to other stented bioprostheses (SB), the Perceval valve had similar outcomes. Four prospective and four retrospective clinical studies showed that 30-day mortality was higher in the Perceval group which may be explained with the higher preoperative risk in this population (24)(25)(26)(27)(28)(29)(30)(31). Mortality ranged from 0 to 6.4% for Perceval and 0-5.9% for SB.…”