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Prosthesis–patient mismatch (PPM) remains a concern after valve replacement. This study sought to evaluate the hemodynamic performance of a new low profile stented pericardial tissue bioprosthesis (Trifecta, St. Jude Medical, St. Paul, MN) for aortic valve replacement; compared to a widely used stented bioprosthetic pericardial valve (Epic, St. Jude Medical, St. Paul. MN).
From January 2010 to May 2012, 125 patients (mean age 73.6 ± 11.0 years) had aortic valve replacement for stenosis (93.5%) or regurgitation (6.5%). Prosthetic valve types used were Trifecta (n=75, 60.5%) and Epic (n=49, 39.5%). Intraoperative 3D and Doppler transesophageal echocardiography (TEE) was used to evaluate hemodynamic variables pre– and post– replacement as well as pre–discharge.
Baseline demographics were similar in both groups. Post–operative mean pressure gradient (MG) measurements demonstrate significantly improved hemodynamic performance in favor of the Trifecta valve (Fig. 1). Compared to the Trifecta, postoperative MG demonstrate a shift upwards in the Epic hemodynamic curve for any given valve effective orifice area (EOA) indicating higher relative obstructions to flow with smaller valve sizes. Severe PPM (defined as (EOAI ≤ 0.65) was more frequent in the Epic than Trifecta group (28% vs. 6%, p=0.0011).
The hemodynamic performance of the Trifecta valve is superior to the Epic valve across all prosthesis sizes and resulted in substantially lower rates of severe PPM.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Valvular Heart Disease: Clinical VI – Prosthetic Valve
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1241–77
- 2013 American College of Cardiology Foundation