Pulmonary Valve Replacement With a Trifecta Valve Is Associated With Reduced Transvalvular Gradient

Abstract

Outcomes after surgical pulmonary valve replacement (PVR) in patients with congenital cardiac disease are limited by long-term valve deterioration, which may be hastened by turbulent flow. The use of theTrifecta valve (St. Jude Medical, Little Canada, MN) at our institution (Duke University Medical Center, Durham, NC) appears to result in low postimplantation transvalvular gradients. This study was performed to compare the early transvalvular gradient associated with the Trifecta valve with that associated with two other valves commonly used for PVR. We performed a single institution review of patients undergoing PVR with the Perimount valve (Edwards Lifesciences, Irvine, CA), the Biocor valve (St. Jude Medical), or the Trifecta valve between November 1993 and January 2014. Multivariable linear regression modeling was used to determine the adjusted association between valve type and transvalvular gradient as determined by early postoperative echocardiography. A total of 186 patients met study criteria; 54(29%) received a Biocor valve, 87 (47%) received a Perimount valve, and 45 (24%) received a Trifecta valve. There were no baseline differences among the groups, but the peak transvalvular gradient was significantly decreased among patients with the Trifecta valve. After adjustment for age, valve size, patients' weight, and time to the assessment, as compared with the Trifecta valve, the Biocor valve was associated with a 57% higher peak valve gradient (p < 0.01), whereas the Perimount valve was associated with a 26% higher peak valve gradient (p= 0.04). PVR for congenital heart disease with the Trifecta bioprosthetic valve is associated with a reduced early transvalvular gradient. This finding may be associated with reduced valve deterioration over time.