St. Jude Medical Trifecta™ aortic valve perioperative performance in 200 patients

Abstract

Objectives: The St. Jude Medical Trifecta aortic bioprosthesis (St. Jude Medical, Inc., St. Paul, MN, USA) is a new stented pericardial tissue heart valve. The aim of the study was to evaluate the clinical and haemodynamic performance of the Trifecta bioprosthesis in the early postoperative period.

Methods: From July 2010 to September 2012, a total of 200 consecutive patients underwent aortic valve replacement with the Trifecta valve in our institution. All intraoperative and postoperative data were prospectively collected. Mean EuroSCORE II was 3.98%. Echocardiography was performed at discharge in all patients.

Results: The mean age was 71.2 ± 7.7 (range 39-89 years). Extubation in the operating theatre was successfully performed in 96% of patients. Mean hospital stay was 8.5 days. The prosthesis sizes were 19 mm (n = 33), 21 mm (n = 81), 23 mm (n = 59), 25 mm (n = 23) and 27 mm (n = 4). Mean systolic pressure gradients ranged from 9.4 mmHg (size 19 valve) to 4.8 mmHg (size 27 valve). Mean effective orifice area (EOA) ranged from 1.61 cm(2) (size 19 valve) to 2.5 cm(2) (size 27 valve). Severe mismatch (<0.65 cm(2)/m(2)) did not occur in any patient. Of note, 99.5% of patients had mild or no aortic insufficiency at discharge. The early (30-day) mortality was 2.5% (n = 5).

Conclusions: The Trifecta valve offers good clinical results and excellent haemodynamic performance. Special care must be taken to avoid oversizing, which can lead to difficulty in implantation and can produce gradient increases due to an excess of prosthetic leaflet tissue.

Keywords: Aortic valve; Mean effective orifice area; Mean systolic pressure gradients; Trifecta bioprosthesis.

Figure 1:

Trifecta valve mean and peak gradients. Valve size (mm) in the x-axis.

Figure 2:

Trifecta valve effective orifice areas (EOA) comparing the results from St. Jude Medical and our institution, Hospiten Rambla.