Comparison of early hemodynamic performance of 3 aortic valve bioprostheses

Abstract

The study objective was to determine whether the new-generation Trifecta (St Jude Medical Inc, St Paul, Minn) bovine aortic valve bioprosthesis, which is designed for supra-annular positioning, produces early postoperative hemodynamic results comparable to or better than those of the Mitroflow (Sorin Group, Milan, Italy) or Perimount Magna (Edwards Lifesciences Corp, Irvine, Calif) bovine aortic valve bioprostheses. We retrospectively reviewed the medical records of patients who underwent aortic valve replacement with a Trifecta, Mitroflow, or Perimount Magna bovine pericardial prosthesis at Mayo Clinic between June 2007 and December 2012 and analyzed early postoperative hemodynamic performance by Doppler echocardiography. A total of 1436 patients underwent aortic valve replacement (Trifecta in 196, Mitroflow in 1135, Perimount Magna in 105). Preoperative characteristics and early clinical outcomes were similar among the 3 valve groups. The average mean gradients were lower and valve areas were greater with the Trifecta valves. For the Trifecta, Mitroflow, and Perimount Magna valves, the average mean gradient was 11.4 mm Hg, 16.9 mm Hg, and 14.1 mm Hg, respectively; the effective orifice area was 2.22 cm2, 1.85 cm2, and 2.09 cm2, respectively; and the indexed effective orifice area was 1.14 cm2/m2, 0.96 cm2/m2, and 1.07 cm2/m2, respectively (all P<.001). Similar statistical significance was found when data were stratified by valve size. Severe prosthesis-patient mismatch (indexed effective orifice area<0.60 cm2/m2) was detected in 1.3% of patients (n=2/150) with the Trifecta, 5.8% of patients (n=44/758) with the Mitroflow, and 3.2% of patients (n=3/95) with the Perimount Magna (P=.048). Early hemodynamic postoperative performance of the Trifecta bioprosthesis is favorable. Additional follow-up should determine whether these small hemodynamic differences will persist and influence later clinical outcomes.