Author + information
- Karla Campos–Arce,
- Mayralexandra Barreda,
- Roberto Cervera,
- Ross Reul,
- Joseph Coselli,
- Ourania Preventza,
- Nishant Shah,
- Suwei Wang and
- Raymond Stainback
Newer generation bioprosthetic aortic valves (AV) may confer a hemodynamic advantage over older models. Premarket data suggest that the Trifecta AV results in indexed orifice areas (EOAi) associated with single–digit mean pressure gradients at 1–year after AV replacement. However, real–world hemodynamic performance data and head–to–head comparison against older models such as the Mosaic are not known.
Transthoracic Doppler echocardiography was performed in 166 patients after AV surgery, 96 patients received a Trifecta (mean age 74, 47% women, 19mm–25mm) while 70 patients received a Mosaic (mean age 69, 31%women, 21mm–29mm).
Postoperative average mean and peak AV gradient for Trifecta were 10.7 mmHg (CI 9.5–11.8) and 20.2 mmHg (CI 18.2–22.1) vs 15.8 mmHg (CI 14.1–17.4) and 28.8 mmHg (CI 25.4–31.8) for Mosaic (p<0.0001 for both). Mean gradients for the Mosaic were twice as high as those for Trifecta for valve sizes 21 mm (20.5 mmHg vs 10.3 mmHg); and 23 mm (20.6 mmHg vs 9.3). Left Ventricular Outflow Tract (LVOT) Velocity–Time Integral (VTI) for both valves was similar at 21.2 vs 21.5 (p=0.77). The average Velocity Ratio (VR=LVOT VTI/AV VTI) for Trifecta was 0.66 and 0.51 for Mosaic (p<0.0001). There were no cases of severe mismatch (EOAi<0.65) in the Trifecta group vs 8 cases or 11% for Mosaic.
The hemodynamic Doppler indices of the Trifecta AV are superior to those of the Mosaic AV across all valve sizes with lower VR consistent with low resistance to aortic valve outflow.
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: 1241–83
- 2013 American College of Cardiology Foundation