EComment. Trifecta: the latest generation of bioprosthetic aortic valves

Abstract

I read with great interest the paper by Permanyer et al., in which they evaluated the early haemodynamic performance of the St. Jude Medical Trifecta valve, a new biological aortic valve, in 200 consecutive patients in a single-centre experience [1]. The Trifecta valve (St. Jude Medical Inc., St. Paul, MN, USA) was introduced into clinical practice in Europe in 2009. This novel biological prosthesis has a unique valve design that maximizes valve haemodynamics without increasing leaflet stress. It is a three-leaflet stented bovine pericardial valve processed with ethanol-based Linx anticalcification technology, and specially designed to be implanted at the supra-annular aortic position. In addition, the titanium stent may offer supplementary clinical benefit during exercise due to its intrinsic expandability. Dell'Aquila et al. [2] were the first to publish their initial experience with this valve by evaluating the outcomes in 70 patients. They concluded that this novel bioprosthesis offers excellent haemodynamic performance in the early postoperative period. Bavaria et al. [3] recently published the results of one of the largest prospective, multicentre clinical study ever performed on any surgical aortic valve prosthesis. This trial aimed to establish the early clinical and haemodynamic performance of the Trifecta valve. They enrolled 1014 patients from 31 centres. The mean age of the population was 72.5 ± 9 years and the median follow-up interval was 0.9 years. Kaplan-Meier survival was 95.8% at 1 year and 94.5% at 2 years. Freedom from valve-related mortality and from valve explant was 99.4% at 2 years. Haemodynamic performance of the valve was excellent in the postoperative period. At 1 year of follow-up, average mean gradients ranged from 10.7 to 4.7 mmHg for valve sizes 19 to 29 mm. Average effective orifice area ranged from 1.41 to 2.35 cm2 at 1 year for valve sizes 19 to 29 mm. In conclusion, in the above-mentioned trial, the St. Jude Medical Trifecta valve demonstrated excellent early and at one year hemodynamic performance. Nevertheless, future studies with long-term outcomes are mandatory to confirm the promising results of this new bioprosthesis. Conflict of interest: none declared