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Bavaria JE, Mumtaz MA, Griffith B, Svensson LG, Pibarot P, Borger MA, Thourani VH, Blackstone EH, Puskas JD. Five-Year Outcomes After Bicuspid Aortic Valve Replacement With a Novel Tissue Bioprosthesis. Ann Thorac Surg 2024; 118:173-179. [PMID: 38135262 DOI: 10.1016/j.athoracsur.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND This study investigated the safety and effectiveness of surgical aortic valve replacement with RESILIA tissue (Edwards Lifesciences) through 5 years in patients with native bicuspid aortic valves. Outcomes were compared with those for patients with tricuspid aortic valves. METHODS Of 689 patients from the COMMENCE (ProspeCtive, nOn-randoMized, MulticENter) trial who received the study valve, 645 had documented native valve morphology and core laboratory-evaluable echocardiograms from any postoperative visit, which were used to model hemodynamic outcomes over 5 years. Linear mixed-effects models were used to estimate longitudinal changes in mean gradient and effective orifice area. RESULTS Patients with native bicuspid aortic valves (n = 214) were more than a decade younger than those with tricuspid aortic valves (n = 458; 59.8 ± 12.4 years vs 70.2 ± 9.5 years; P < .001). The bicuspid aortic valve cohort exhibited no structural valve deterioration over 5 years, and rates of paravalvular leak and transvalvular regurgitation were low (0.7% and 2.9%, respectively [all mild] at 5 years). These outcomes mirrored those in patients with native tricuspid aortic valves. The model-estimated postoperative mean gradient and effective orifice area, as well as the rate of change of these outcomes, adjusted for age, body surface area, and bioprosthesis size, did not differ between the 2 cohorts. CONCLUSIONS Among patients with bicuspid aortic valves, RESILIA tissue valves demonstrated excellent outcomes to 5 years, including no structural valve deterioration and very low rates of paravalvular and transvalvular regurgitation. These results are encouraging for RESILIA tissue durability in young patients.
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Affiliation(s)
- Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Mubashir A Mumtaz
- Department of Cardiovascular and Thoracic Surgery, UPMC Central Pennsylvania, Harrisburg, Pennsylvania
| | - Bartley Griffith
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
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Tsukada T, Suzuki Y, Mathis BJ, Sato K, Kawamata T, Imai A, Nakajima T, Kaminishi Y, Kato H, Sakamoto H, Hiramatsu Y. Aortic valve area index values of Trifecta implants correlate with energy loss and increased valve stress. J Artif Organs 2024:10.1007/s10047-024-01453-z. [PMID: 38916826 DOI: 10.1007/s10047-024-01453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/16/2024] [Indexed: 06/26/2024]
Abstract
Biological valves are becoming more frequently used in aortic valve replacement. While several reports have evaluated the performance of biological valves, echocardiography studies during exercise stress remain scarce. Furthermore, no current reports compare rate changes in the aortic valve area of biological valves under increased exercise load. Here, we performed exercise stress echocardiography in patients after AVR with Trifecta or Inspiris valves and compared the rates of change in aortic valve areas (AVA). In addition, hydrodynamic analysis at rest was conducted with four-dimensional flow magnetic resonance imaging (4D-flow MRI). Exercise stress echocardiography was performed in seven Trifecta and seven Inspiris patients who underwent AVR at our hospital while 4D flow MRI was performed in all but two Trifecta cases. Comparing the percentage change in AVA when loaded to 25 W versus at rest, Trifecta was greater than Inspiris (28.7 ± 36.0 vs - 0.8 ± 12.4%). The smaller AVA at rest was considered causative for this. Meanwhile, Trifecta systolic energy loss in the prosthetic valve segment on 4D-flow MRI (97.5 ± 35.9 vs 52.7 ± 25.3 mW) was higher than Inspiris. The opening of the Trifecta valve was considered to be restricted at rest and this may reflect the current reports of early valve degradation requiring reoperation. Taken together, we observed that the Trifecta design may promote faster wear due to higher valve stress.
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Affiliation(s)
- Toru Tsukada
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kimi Sato
- Department of Cardiology, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takeshi Kawamata
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akito Imai
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuichiro Kaminishi
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Chatlaong T, Kosum P, Tumkosit M, Limjareon T. Unusual cause of severe transvalvular eccentric jet AR: early structure valve deterioration of Trifecta valves by flail leaflet undergoing valve-in-valve transcatheter aortic valve replacement. BMJ Case Rep 2024; 17:e256369. [PMID: 38395470 PMCID: PMC10895215 DOI: 10.1136/bcr-2023-256369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
The Trifecta tissue valve (Abbott, Illinois, USA) is an externally mounted bovine pericardial aortic valve (AV) prosthesis with adequate haemodynamic performance and better early results than another option. However, concerns have been raised about its durability. Recently, reports have emerged about an increased incidence of early structural valve failure after Trifecta implantation, where leaflet tear(s) with dehiscence along the stent post was the primary mode of early failure. In this article, we present the case of a patient in her 70s, 7 years after AV replacement with a Trifecta valve, who developed progressive dyspnoea. Physical examination revealed signs of chronic severe aortic regurgitation (AR). The initial transthoracic echocardiogram showed severe transvalvular AR, but the aetiology could not be determined. Cardiac computed tomography (CT) revealed a flail non-coronary cusp of the Trifecta bioprosthetic valve without vegetation. After discussion, we concluded that our patient was suitable for valve-in-valve transcatheter aortic valve replacement (ViV TAVR).
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Affiliation(s)
- Thirath Chatlaong
- Division of Cardiovascular Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Paisit Kosum
- Division of Cardiovascular Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Monravee Tumkosit
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thitima Limjareon
- Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Jayet A, Lu H, Monney P, Verdugo-Marchese M, Gunga Z, Rancati V, Ltaief Z, Kirsch M. Thrombocytopenia among Patients Undergoing Aortic Valve Replacement Using the Sutureless Perceval S Bioprosthesis: A Retrospective Study. J Clin Med 2024; 13:1083. [PMID: 38398396 PMCID: PMC10888618 DOI: 10.3390/jcm13041083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The sutureless Perceval S bioprosthesis is associated with postoperative thrombocytopenia. Our objectives were to compare the incidence, severity, and clinical implications of thrombocytopenia after aortic valve replacement (AVR) using the Perceval S or the Trifecta bioprosthesis. METHODS Patients who underwent AVR between March 2016 and August 2019 using the Perceval or Trifecta were retrospectively included. The primary endpoint was the nadir in platelet counts within 15 days after surgery. Secondary endpoints included postoperative hemolysis and inflammatory parameters, as well as clinical and echocardiographic outcomes. RESULTS Overall, 156 patients were included (Perceval, n = 103; Trifecta, n = 53). Preoperatively, there was no difference in platelet counts between the two groups. Postoperatively, the Perceval S bioprosthesis was associated with a greater decrease in platelet counts. The nadir was reached at Day 3 for both groups, but thrombocytopenia was more severe for the Perceval S (Perceval S vs. Trifecta, 89.2 ± 37.7 × 109/L vs. 106.5 ± 34.1 × 109/L, p = 0.01). No difference regarding lactate dehydrogenase, C-reactive protein, and white blood cells count was found. All-cause 30-day mortality rates (both valves, 2%, p = 0.98), hospital lengths of stay, and re-operation rates were similar. CONCLUSION The Perceval S bioprosthesis was associated with more severe postoperative thrombocytopenia. This did not translate into higher short-term morbidity or mortality.
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Affiliation(s)
- Adrien Jayet
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Henri Lu
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (H.L.)
| | - Pierre Monney
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (H.L.)
| | - Mario Verdugo-Marchese
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Ziyad Gunga
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Valentina Rancati
- Department of Anaesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Zied Ltaief
- Adult Intensive Care Unit, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Matthias Kirsch
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
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5
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Tnay TD, Kang L, Mekhail A, Galvin SD. Case Series of Early Structural Valve Deterioration of Trifecta Bioprosthesis - New Zealand Experience. Ann Thorac Cardiovasc Surg 2023; 29:233-240. [PMID: 36935120 PMCID: PMC10587479 DOI: 10.5761/atcs.oa.23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE Structural valve deterioration (SVD) remains a limitation on the use of bioprosthetic valves, with patient and valve-related factors contributing to early SVD. The Trifecta valve has been reported to have excellent hemodynamics but studies have highlighted early failure. We present a review and case series at a New Zealand tertiary hospital defining early SVD as failure within 3 years of implant. METHODS A retrospective review from January 2015 to July 2019 included 525 patients undergoing surgical aortic valve replacement with 263 patients receiving an Abbott Trifecta or Trifecta Glide Technology (GT) valve. Our review found an acceptable safety profile for the valve with excellent hemodynamics, with a low mortality, stroke, and permanent pacemaker rate. RESULTS Three patients out of 263 were identified from the study period as having early SVD requiring reintervention within 3 years of valve implantation leading to a 1.14% failure rate. One of the valves that had early SVD was a new generation Trifecta GT. An additional four patients were identified to have valves implanted prior to the study period and had valve failure at greater than 3 years post implantation. Five cases had cusp tears as their mechanism of failure, raising concerns about durability. CONCLUSION The Trifecta valve has an acceptable safety profile and offers good hemodynamics due to the externally mounted leaflets. However, our experience of early SVD and failure is concerning for valve durability. Further comparison to other bioprosthetic valves and longer term follow-up are required to characterize the mechanism of failures.
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Affiliation(s)
- Trevor D Tnay
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, St Vincent's Health Australia, Melbourne, Australia
| | - Lily Kang
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, St Vincent's Health Australia, Melbourne, Australia
| | - Andrew Mekhail
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sean D Galvin
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
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6
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Demal TJ, Weimann J, Ojeda FM, Bhadra OD, Linder M, Ludwig S, Grundmann D, Voigtländer L, Waldschmidt L, Schirmer J, Schofer N, Blankenberg S, Reichenspurner H, Conradi L, Seiffert M, Schaefer A. Temporal changes of patient characteristics over 12 years in a single-center transcatheter aortic valve implantation cohort. Clin Res Cardiol 2023; 112:691-701. [PMID: 36792752 PMCID: PMC10160189 DOI: 10.1007/s00392-023-02166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Beneficial results of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in patients at all risk strata have led to substantial changes in guideline recommendations for valvular heart disease. AIM To examine influence of these guideline changes on a real-world TAVI cohort, we evaluated how risk profiles and outcomes of TAVI patients developed in our single-center patient cohort over a period of 12 years. METHODS Baseline, procedural and 30-day outcome parameters of TAVI patients were retrospectively compared between three time periods (period 1: 2008-2012, period 2: 2013-2017, period 3: 2018-2020). RESULTS Between 03/2008 and 12/2020, a total of 3678 patients underwent TAVI at our center. The median age was 81.1 years (25th, 75th percentile: 76.7, 84.9) with no significant change over time. The EuroSCORE II showed a continuous and significant decline from 5.3% (3.3, 8.6) in period 1 to 2.8% (1.7, 5.0) in period 3 (p < 0.001). Furthermore, rates of permanent pacemaker implantation, acute kidney injury, and paravalvular leakage ≥ moderate continuously declined over time. Accordingly, the 30-day mortality fell from 9.3% in period 1 to 4.3% in period 3 (p < 0.001). CONCLUSION Despite substantial guideline alterations, median patient age remained largely unchanged in our TAVI cohort over the past 12 years. Therefore, increased age still appears to be the main reason to choose TAVI over SAVR. However, risk profiles declined substantially. Significant improvements in early outcomes suggest favorable influence of less invasive access routes, improved device platforms and growing user experience.
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Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Francisco Miguel Ojeda
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
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7
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Yokoyama Y, Sakurai Y, Kuno T, Takagi H, Fukuhara S. Externally mounted versus internally mounted leaflet aortic bovine pericardial bioprosthesis: meta-analysis. Gen Thorac Cardiovasc Surg 2023; 71:207-215. [PMID: 36598643 DOI: 10.1007/s11748-022-01904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent studies reported higher-than-expected rates of early structural valve degeneration (SVD) and/or reoperation of externally mounted leaflet aortic bioprosthesis compared with others. This meta-analysis aims to compare the outcomes of bioprostheses with externally versus internally mounted leaflet design in patients who underwent surgical aortic valve replacement (SAVR). METHODS MEDLINE and EMBASE were searched through November 2021 to identify comparative studies investigating outcomes following SAVR with either externally or internally mounted leaflet aortic bioprosthesis. Outcomes of interest were reoperation for SVD or any cause and all-cause mortality. RESULTS Our analysis included 15 observational studies that enrolled a total of 23,539 patients who underwent SAVR using externally mounted (n = 9338; 39.7%) or internally mounted leaflet (n = 14,201; 60.3%) bioprostheses. Externally mounted valves consisted of the Trifecta (Abbott, St Paul, MN) (n = 6146) and the Mitroflow (LivaNova, London, UK) (n = 3192), and all internally mounted valves were the Perimount (Edwards Lifesciences, Irvine, CA). Externally mounted valves compared with the Perimount were associated with higher reoperation rates for SVD [hazard ratio (HR) 3.55, 95% confidence interval (CI) 2.67-4.72; P < 0.001] and any cause (HR 9.36, 95% CI 3.70-23.67; P < 0.001). Furthermore, externally mounted valves demonstrated higher all-cause mortalities (HR 1.33, 95% CI 1.13-1.56; P < 0.001). CONCLUSIONS The present study summarizing updated evidence revealed higher reoperation rates and all-cause mortalities in patients with externally mounted leaflet aortic bioprostheses compared with those with internally mounted design. Choosing the right SAVR valve type is critical part of lifetime management of aortic valve disease.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WV, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY, 10467-2401, USA.
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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8
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Toto F, Leo L, Klersy C, Torre T, Theologou T, Pozzoli A, Caporali E, Demertzis S, Ferrari E. Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10040139. [PMID: 37103018 PMCID: PMC10146805 DOI: 10.3390/jcdd10040139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Aims of the Study: We evaluated the clinical outcome and the hemodynamic and freedom from structural valve degeneration of two standard aortic bioprostheses. Methods: Clinical results, echocardiographic findings and follow-up data of patients operated for isolated or combined aortic valve replacement with the Perimount or the Trifecta bioprosthesis were prospectively collected, retrospectively analysed and compared. We weighted all the analyses by the inverse of the propensity of choosing either valves. Results: Between April 2015 and December 2019, 168 consecutive patients (all comers) underwent aortic valve replacement with Trifecta (n = 86) or Perimount (n = 82) bioprostheses. Mean age was 70.8 ± 8.6 and 68.8 ± 8.6 years for the Trifecta and Perimount groups, respectively (p = 0.120). Perimount patients presented a greater body mass index (27.6 ± 4.5 vs. 26.0 ± 4.2; p = 0.022), and 23% of them suffered from angina functional class 2–3 (23.2% vs. 5.8%; p = 0.002). Mean ejection fraction was 53.7 ± 11.9% (Trifecta) and 54.5 ± 10.4% (Perimount) (p = 0.994), with mean gradients of 40.4 ± 15.9 mmHg (Trifecta) and 42.3 ± 20.6 mmHg (Perimount) (p = 0.710). Mean EuroSCORE-II was 7 ± 11% and 6 ± 9% for the Trifecta and Perimount group, respectively (p = 0.553). Trifecta patients more often underwent isolated aortic valve replacement (45.3% vs. 26.8%; p = 0.016) and annulus enlargement (10.5% vs. 2.4%; p = 0.058). All-cause mortality at 30 days was 3.5% (Trifecta) and 8.5% (Perimount), (p = 0.203) while new pacemaker implantation (1.2% vs. 2.5%; p = 0.609) and stroke rate (1.2% vs. 2.5%; p = 0.609) were similar. Acute MACCE were observed in 5% (Trifecta) and 9% (Perimount) of patients with an unweighted OR of 2.22 (95%CI 0.64–7.66; p = 0.196) and a weighted OR of 1.10 (95%CI: 0.44–2.76, p = 0.836). Cumulative survival at 24 months was 98% (95%CI: 0.91–0.99) and 96% (95%CI: 0.85–0.99) for Trifecta and Perimount groups, respectively (log-rank test; p = 0.555). The 2-year freedom from MACCE was 94% (95%CI: 0.65–0.99) for Trifecta and 96% (95%CI: 0.86–0.99) for Perimount (log-rank test; p = 0.759, HR 1.46 (95%CI: 0.13–16.48)) in the unweighted analysis (not estimable in the weighted analysis). During the follow-up (median time: 384 vs. 593 days; p = 0.0001) there were no re-operations for structural valve degeneration. Mean valve gradient at discharge was lower for Trifecta across all valve sizes (7.9 ± 3.2 vs. 12.1 ± 4.7 mmHg; p < 0.001), but the difference did not persist during follow-up (8.2 ± 3.7 mmHg for Trifecta, 8.9 ± 3.6 mmHg for Perimount; p = 0.224); Conclusions: Postoperative outcome and mid-term follow-up were similar. An early better hemodynamic performance was detected for the Trifecta valve but did not persist over time. No difference in the reoperation rate for structural valve degeneration was found.
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Affiliation(s)
- Francesca Toto
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +41-918055145; Fax: +41-918055148
| | - Laura Leo
- Department of Cardiology, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Tiziano Torre
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Thomas Theologou
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Elena Caporali
- Department of Cardiology, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- School of Medicine, University of Zurich, 8006 Zurich, Switzerland
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9
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AlBadri A, Joseph J, Patel V, Patel D, Koren O, Cheng W, Jilaihawi H, Makkar R. Hemodynamic and Mid-Term Outcomes for Transcatheter Aortic Valve Replacement in Degenerated Internally Stented Valves. JACC Cardiovasc Interv 2023; 16:542-554. [PMID: 36922040 DOI: 10.1016/j.jcin.2023.01.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement is indicated in patients undergoing repeat intervention for degenerative aortic valve bioprostheses. Patients with internally stented valves (ie, Mitroflow and Trifecta) are at high risk for coronary artery obstruction during ViV procedures because of valve design, as the leaflets are mounted outside the valve stent. OBJECTIVES The aim of this study was to compare the hemodynamic and clinical outcomes of transcatheter aortic valve replacement within internally stented valves (ViV-IS) vs other surgical valves (ViV-OS). METHODS Baseline characteristics, hemodynamic parameters, and clinical outcomes of patients who underwent ViV-IS were retrospectively collected and compared with those of patients who underwent ViV-OS. RESULTS A total of 250 patients (65% men, median Society of Thoracic Surgeons score 4.4% [IQR: 2.2%-8.4%]) were included. Seventy-one patients (28%) underwent ViV-IS, and 179 (72%) patients underwent ViV-OS. Patients who underwent ViV-OS had better periprocedural hemodynamic status compared with those who underwent ViV-IS (median mean gradient 6 [IQR: 2-13] vs 12 [IQR: 6-16]; P < 0.001). This was not significantly different when both groups were matched on the basis of age, sex, and valve internal diameter size (median mean gradient: 18 [IQR: 13-25] for ViV-OS vs 18 [IQR: 11-24] for ViV-IS; P = 0.36). Coronary protection for potential occlusion was performed more in ViV-IS vs ViV-OS pr (79% vs 6%, respectively; P < 0.001). Patients who underwent ViV-IS had a higher risk for coronary occlusion, requiring stent deployment, compared with those who underwent ViV-OS (54% vs 3%, respectively; P < 0.001. There was no difference in mortality at 3 years between the 2 groups (P = 0.59). CONCLUSIONS Patients who underwent ViV-IS had a very high incidence of coronary compromise that can be safely and effectively treated. In the setting of a systematic coronary protection strategy, ViV-OS and ViV-IS provide similar mid-term outcome, and periprocedural hemodynamic status (following adjustment for age, sex, and true internal diameter).
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Affiliation(s)
- Ahmed AlBadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jubin Joseph
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ofir Koren
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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10
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Toggweiler S, Moccetti F, Matt P. Internally Stented Bioprosthetic Heart Valves Should Not Be Used Any More. JACC Cardiovasc Interv 2023; 16:555-557. [PMID: 36922041 DOI: 10.1016/j.jcin.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Affiliation(s)
| | | | - Peter Matt
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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11
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Pollari F, Mamdooh H, Hitzl W, Grossmann I, Vogt F, Fischlein T. Ten years' experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2023; 63:6935788. [PMID: 36534823 DOI: 10.1093/ejcts/ezac572] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Aortic valve replacement with a sutureless prosthesis [sutureless aortic valve replacement (Su-AVR)] is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking. METHODS All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our centre between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure. RESULTS Study population consisted of 547 patients: the mean age was 76.4 (5.2) years, 51% were female and the mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years [95% confidence interval (CI) = 6.9-8.6]. Risk factor analysis identified age [hazard ratio (HR) 1.06, 95% CI 1.03-1.11; P < 0.001), EuroSCORE II (HR 1.08, 1.02-1.13; P < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4-4.4; P = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58-17.6; P < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per 1 year and for EuroSCORE II is 1 percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of whom 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82-0.95; P < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis. CONCLUSIONS The sutureless valve represents a reliable bioprosthesis for aortic valve replacement in patients with a 10-year life expectancy. Younger age at the time of implant is the only factor associated with the risk of long-term SVD.
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Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Hazem Mamdooh
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research and Innovation Management (RIM) Department, Biostatistics and Publication of Clinical Trials, Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Irena Grossmann
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
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12
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Unai S, Ozaki S, Johnston DR, Saito T, Rajeswaran J, Svensson LG, Blackstone EH, Pettersson GB. Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective. J Am Heart Assoc 2023; 12:e027391. [PMID: 36628965 PMCID: PMC9939068 DOI: 10.1161/jaha.122.027391] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity-matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28 mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6 years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use.
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Affiliation(s)
- Shinya Unai
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Shigeyuki Ozaki
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Tomohiro Saito
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH,Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
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13
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Tsui S, Rosenbloom M, Abel J, Swanson J, Haverich A, Zacharias J, Schorlemmer G, Cohen G, Moulton M, Lange R. Eight-year outcomes of aortic valve replacement with the Carpentier-Edwards PERIMOUNT Magna Ease valve. J Card Surg 2022; 37:4999-5010. [PMID: 36378942 PMCID: PMC10100054 DOI: 10.1111/jocs.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Carpentier-Edwards PERIMOUNT Magna Ease valve is a third-generation bioprosthesis for aortic valve replacement (AVR). This is a postapproval study reporting on its 8-year outcomes. METHODS Adults undergoing AVR with the Magna Ease valve between October 2007 and December 2012 were enrolled for this prospective, nonrandomized, single-arm, and multicenter study. Assessments occurred preoperatively, at hospital discharge, 6 months, 1 year, and annually thereafter for up to 8 years. Outcomes included safety endpoints, hemodynamic performance, and New York Heart Association (NYHA) functional class. RESULTS Of the 258 study patients, 67.5% were in NYHA Class I or II, and 32.5% were in NYHA Class III or IV at baseline. Concomitant procedures were performed in 44.2%. Total follow-up was 1597.6 patient-years, and median follow-up was 7 years (interquartile range: 5.5-8.0 years). Eight years following AVR, the functional class remained improved from baseline with 93.9% in NYHA Class I/II and 6.1% in NYHA Class III; 38 deaths had occurred, 8 of which were valve related; freedom from all-cause mortality was 80.7% (95% confidence intervals: 74.9, 86.4); freedom from valve-related mortality was 95.8% (92.8, 98.8); freedom from reintervention, explant, major bleeding events, and structural valve deterioration was 89.8% (85.1, 94.6), 94.8% (91.7, 97.9), 85.1% (80.0, 90.1), and 90.1% (84.7, 95.4), respectively; effective orifice area was 1.5 ± 0.5 cm2 , the mean gradient was 14.8 ± 8.3 mmHg, and 88.6% of patients had no or trivial aortic regurgitation. CONCLUSIONS This study demonstrated satisfactory safety and sustained hemodynamic and functional improvements at 8 years following AVR with the Magna Ease valve.
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Affiliation(s)
- Steven Tsui
- Department of Cardiothoracic Surgery and Transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Michael Rosenbloom
- Division of Cardiothoracic Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - James Abel
- Division of Cardiac and Thoracic Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Swanson
- Providence Heart Valve Clinic, Providence St Vincent's Hospital, Portland, Oregon, USA
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - Gilbert Schorlemmer
- Department of Cardiac, Vascular and Thoracic Surgery, St Mark's Hospital, Salt Lake, Utah, USA
| | - Gideon Cohen
- Department of Surgery, Division of Cardiac Surgery, Sunnybrook Health Sciences Center, North York, Ontario, Canada
| | - Michael Moulton
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Bavaria, Germany
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14
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Tnay TD, Shell D, Lui A. Review of bioprosthetic structural valve deterioration: Patient or valve? J Card Surg 2022; 37:5243-5253. [PMID: 36317394 DOI: 10.1111/jocs.17081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND With guidelines progressively recommending bioprosthetic aortic valves in younger patients, a greater emphasis is placed on structural valve deterioration (SVD) as an important clinical endpoint for both transcatheter and surgically implanted valves. However, SVD of bioprosthetic valves is a complex entity with varying definitions in the literature and a multifaceted pathogenesis. AIM This review first aims to establish the most updated definitions of SVD as per the literature. We then explore the patient- and valve-related factors that play the greatest roles in facilitating early SVD. METHODS A PubMed literature review was conducted to identify the relevant research in this field within the past two decades. CONCLUSION Increasing rates of obesity and metabolic syndrome pose a significant risk to the longevity of bioprosthetic valves. Additionally, externally mounted valves have proven to sacrifice durability for superior haemodynamics. Bioprosthetic SVD continues to be a multifactorial issue that will require various patient- and valve-related factors to be addressed.
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Affiliation(s)
- Trevor D Tnay
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
| | - Daniel Shell
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
| | - Adrienne Lui
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
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15
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Durabilidad de la bioprótesis Trifecta™ a medio plazo: experiencia de un centro. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Malvindi PG, Kattach H, Luthra S, Ohri S. Modes of failure of Trifecta aortic valve prosthesis. Interact Cardiovasc Thorac Surg 2022; 35:6554752. [PMID: 35348698 PMCID: PMC9297516 DOI: 10.1093/icvts/ivac086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pietro Giorgio Malvindi
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Hassan Kattach
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
- University of Southampton , Southampton, UK
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
- University of Southampton , Southampton, UK
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17
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Klautz RJM, Dagenais F, Reardon MJ, Lange R, Moront MG, Labrousse L, Weissman NJ, Rao V, Patel HJ, Liu F, Sabik JF. Surgical aortic valve replacement with a stented pericardial bioprosthesis: 5-year outcomes. Eur J Cardiothorac Surg 2022; 62:6631229. [PMID: 35789382 PMCID: PMC9346377 DOI: 10.1093/ejcts/ezac374] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/21/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This analysis evaluated the safety, durability, and haemodynamic performance of a stented bovine pericardial valve through 5 years of follow-up in patients with an indication for surgical aortic valve replacement (SAVR). METHODS Kaplan-Meier analysis was used to estimate the incidence of survival and valve-related thromboembolism, major paravalvular leak (PVL), endocarditis, structural valve deterioration (SVD), and reintervention. Mean aortic gradient and New York Heart Association (NYHA) class were also evaluated. RESULTS 1118 patients have received the Avalus valve (Medtronic); 564 have completed 5-year follow-up. Median follow-up was 4.85 years (4810 patient-years total follow-up). At baseline, mean age was 70.2 ± 9.0 years; 75.1% of patients were male. STS predicted risk of mortality was 2.0 ± 1.4%. Most patients were in NYHA class II (46.8%) or III (40.3%). At 5 years follow-up, the overall Kaplan-Meier survival rate was 88.1% (85.9-90.0%). The Kaplan-Meier event rates were 5.6% (4.3-7.2%) for thromboembolism, 4.4% (3.2-6.0%) for endocarditis, 0.2% (0.0-0.7%) for major PVL, and 3.2% (2.3-4.6%) for reintervention. There were no cases of SVD. Mean gradient decreased from 42.1 ± 17.1 mmHg at baseline, to 13.1 ± 4.7 mmHg at discharge, and remained stable at 12.5 ± 4.6 mmHg at 5 years. More than 95% of patients were in NYHA class I/II 5 years after surgery. CONCLUSIONS The findings of a high survival rate, excellent safety, no SVD, and stable haemodynamic performance and functional status through 5 years of follow-up are encouraging. Additional follow-up is needed to assess the long-term durability of this contemporary surgical bioprosthesis.
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Affiliation(s)
- Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - François Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, Bordeaux Heart University Hospital, Bourdeaux-Pessac, France
| | - Neil J Weissman
- MedStar Health Research Institute, MedStar Health, Washington, DC
| | - Vivek Rao
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Himanshu J Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Fang Liu
- Cardiac Surgery Clinical Research and Medical Science, Medtronic, Mounds View, Minnesota
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
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18
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The role of mechanical valves in the aortic position in the era of bioprostheses and TAVR: Evidence-based appraisal and focus on the On-X valve. Prog Cardiovasc Dis 2022; 72:31-40. [PMID: 35738422 DOI: 10.1016/j.pcad.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
Abstract
Patients who need a prosthetic aortic heart valve may decide, working with their cardiologist and cardiac surgeon, among a variety of options: surgical or transcatheter approach, bioprosthetic or mechanical valve, or a Ross procedure if suitable to their age and anatomy. This review article examines the evidence for survival benefit with mechanical aortic valves, discusses bioprosthetic structural valve degeneration and its consequences, and considers the risks of redo aortic valve surgery or subsequent valve-in-valve (ViV) transcatheter intervention. It highlights the unique characteristics of the On-X aortic valve, including the US Food and Drug Administration approved and American College of Cardiology/American Heart Association guideline supported reduced anticoagulation target INR of 1.5 to 2.0, and discusses the PROACT Xa trial comparing apixaban vs warfarin anticoagulation. The choice of prosthetic valve should be individualized, carefully considering each patient's unique circumstances. In that context, the On-X aortic valve offers a potential lifetime solution without need for a repeat operation, while minimizing the risks of long-term anticoagulation. In an era of enthusiasm for bioprosthetic and transcatheter-based approaches, the option of a second-generation bileaflet mechanical valve with optimized hemodynamics-the On-X aortic valve-may well align with patient expectations.
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19
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Suzuki R, Ito T, Suzuki M, Ohori S, Takayanagi R, Miura S. Trifecta versus Perimount Magna Ease aortic valves: Failure mechanisms. Asian Cardiovasc Thorac Ann 2022; 30:797-806. [PMID: 35603636 PMCID: PMC9373186 DOI: 10.1177/02184923221100994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background There are increasing reports of early externally mounted pericardial Trifecta
bioprosthesis failure. We compared the hemodynamic performance of Trifecta
and Carpentier–Edwards Perimount Magna Ease valves to determine the failure
mechanism. Methods We retrospectively included 270 consecutive patients (age: 73.4 ± 8.2 years;
57.5% male; mean follow-up: 48.0 ± 20.3 months) who underwent aortic valve
replacement from 2014 to 2021 at a single center and compared the Trifecta
(N = 137) and Carpentier–Edwards Perimount Magna Ease
valve (N = 133) patients. Results The prosthetic valve major aortic regurgitation incidence was higher for the
Trifecta than that for the Carpentier–Edwards Perimount Magna Ease valve
(6.3% vs. 0%, P < 0.009). Among the Trifecta failures,
33% developed structural valve deterioration, but all requiring redo aortic
valve replacement developed major prosthetic valve aortic regurgitation.
Freedom at 5 years from redo aortic valve replacement due to structural
valve deterioration was significantly lower for Trifecta (89.4% vs. 100%,
P = 0.003). The reoperation hazards were determined for
Trifecta (vs. Carpentier–Edwards Perimount Magna Ease): 11.6 (1.47–90.9;
P = 0.02), prosthetic valve aortic regurgitation: 2.38
(1.70–3.32; P < 0.01), structural valve deterioration:
20.82 (4.08–106.2; P < 0.01), 5-year mean
transprosthetic pressure gradient: 1.14 per 1-point increase (1.03–1.24;
P = 0.007), and urgent surgery: 10.1 (2.59–39.0;
P = 0.001). The Cox regression analysis identified that
prosthetic valve aortic regurgitation solely contributed to redo aortic
valve replacement (hazard ratio: 2.38; confidence intervals: 1.70–3.32). Conclusions Significantly, more early failures occurred with the Trifecta valve than the
Carpentier–Edwards Perimount Magna Ease valve but the Trifecta showed
reasonable mean transprosthetic pressure gradient over time. Prosthetic
valve aortic regurgitation and calcific structural valve deterioration
synergistically contributed to Trifecta valve failure alternatively.
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Affiliation(s)
- Ryo Suzuki
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Masato Suzuki
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Shunsuke Ohori
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Ryo Takayanagi
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Shiro Miura
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
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20
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Yount KW, Hawkins RB, Mehaffey JH, Teman NR, Yarboro LT, Kern JA, Ailawadi G. Aortic valve biologic protheses: A cohort comparison of premature valve failure. J Card Surg 2022; 37:1224-1229. [PMID: 35245397 DOI: 10.1111/jocs.16328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent reports suggest an increased rate of early structural valve degeneration (SVD) in the Trifecta bioprosthesis (Abbott Cardiovascular). We sought to compare the intermediate-term outcomes of the Magna (Edwards Life Sciences) and Trifecta valves. METHODS All surgical aortic valve replacements (SAVRs) with Trifecta or Magna/Magna Ease bioprostheses at an academic medical center were extracted from an institutional database. Patients who survived until after discharge (2011-2019) were included. The primary outcome was valve failure for any reason requiring reintervention or contributing to death, identified by reintervention or review of cause of death. Time to failure was estimated with Kaplan-Meier analysis and Cox Proportional Hazards Modeling. RESULTS Out of 1444 patients, 521 (36%) underwent Trifecta and 923 (64%) underwent Magna implantation with a median follow-up of 27.6 months. Trifecta patients had larger median valve size (25 vs. 23 mm, p < .001) and lower median gradient (8.0 vs. 10.9 mmHg, p < .001). Trifecta patients had higher 48-month estimated failure rates (20.2 ± 7.6% vs. 2.6 ± 0.7%, p < .0001), with failure rates of 21.4 versus 9.2 failures per 1000 person-years (p < .001). After risk-adjustment, Trifecta patients had a 5.3 times hazard of failure (95% confidence interval: 2.78-12.34, p < .001) compared to Magna patients. Only Trifecta valves failed due to sudden aortic regurgitation, 8 out of 521 (1.5%). CONCLUSION Despite lower postoperative mean gradients, the Trifecta bioprosthesis may have an increased risk of intermediate-term SVD. Further research is warranted to confirm the potential for sudden valve failure.
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Affiliation(s)
- Kenan W Yount
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John A Kern
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
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21
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Hui DS. Reply: Pas excellence. JTCVS OPEN 2022; 9:86-87. [PMID: 36003465 PMCID: PMC9390566 DOI: 10.1016/j.xjon.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dawn S Hui
- Department of Cardiothoracic Surgery, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex
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22
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Persson M, Glaser N, Nilsson J, Friberg Ö, Franco-Cereceda A, Sartipy U. Comparison of Long-term Performance of Bioprosthetic Aortic Valves in Sweden From 2003 to 2018. JAMA Netw Open 2022; 5:e220962. [PMID: 35254431 PMCID: PMC8902647 DOI: 10.1001/jamanetworkopen.2022.0962] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The performance of bioprosthetic aortic valves is usually assessed in single valve models or head-to-head comparisons. National databases or registries offer the opportunity to investigate all available valve models in the population and allows for a comparative assessment of their performance. OBJECTIVE To analyze the long-term rates of reintervention, all-cause mortality, and heart failure hospitalization associated with commonly used bioprosthetic aortic valves and to identify valve model groups with deviation in clinical performance. DESIGN, SETTING, AND PARTICIPANTS This population-based, nationwide cohort study included all adult patients who underwent surgical aortic valve replacement (with or without concomitant coronary artery bypass surgery or ascending aortic surgery) in Sweden between January 1, 2003, and December 31, 2018. Patients were identified from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Patients with concomitant valve surgery, previous cardiac surgery, and previous transcatheter valve replacement were excluded. Follow-up was complete for all participants. Data were analyzed from March 9, 2020, to October 12, 2021. EXPOSURES Primary surgical aortic valve replacement with the Perimount, Mosaic/Hancock, Biocor/Epic, Mitroflow/Crown, Soprano, and Trifecta valve models. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative incidence of reintervention, defined as a subsequent aortic valve operation or transcatheter valve replacement. Secondary outcomes were all-cause mortality and heart failure hospitalization. Regression standardization and flexible parametric survival models were used to account for intergroup differences. Mean follow-up time was 7.1 years, and maximum follow-up time was 16.0 years. RESULTS A total of 16 983 patients (mean [SD] age, 72.6 [8.5] years; 10 685 men [62.9%]) were included in the analysis. The Perimount valve model group had the lowest and the Mitroflow/Crown valve model group had the highest cumulative incidence of reintervention. The estimated cumulative incidence of reintervention at 10 years was 3.6% (95% CI, 3.1%-4.2%) in the Perimount valve model group and 12.2% (95% CI, 9.8%-15.1%) in the Mitroflow/Crown valve model group. The estimated incidence of reintervention at 10 years was 9.3% (95% CI, 7.3%-11.3%) in the Soprano valve model group. CONCLUSIONS AND RELEVANCE Results of this study showed that the Perimount valve was the most commonly used and had the lowest incidence of reintervention, all-cause mortality, and heart failure hospitalization, whereas the Mitroflow/Crown valve had the highest rates. These findings highlight the need for clinical vigilance in patients who receive either a Soprano or Mitroflow/Crown aortic bioprosthesis.
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Affiliation(s)
- Michael Persson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Johan Nilsson
- Department of Translational Medicine, Cardiothoracic Surgery and Bioinformatics, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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23
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Kattach H, Barlow CW, Ohri SK. Structural valve deterioration of a pericardial bioprosthesis. JTCVS OPEN 2022; 9:84-85. [PMID: 36003450 PMCID: PMC9390506 DOI: 10.1016/j.xjon.2021.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Fard A, Mahmood Z, Nair S, Shaikhrezai K, Al-Attar N. Analysis of incidence and reasons for re-intervention after aortic valve replacement using the Trifecta aortic bioprosthesis. Curr Probl Cardiol 2022; 48:101125. [PMID: 35114295 DOI: 10.1016/j.cpcardiol.2022.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Trifecta bioprosthesis claims favourable haemodynamic performance. However, reports of structural valve deterioration (SVD) raise concerns of its long-term durability. We assessed outcomes with the Trifecta valve over a 10-year period. METHODS All patients receiving Trifecta bioprostheses between October 2011 and October 2020 were included. Perioperative and survival characteristics were prospectively collated in an independent database. Re-intervention was recorded as a surrogate for SVD. RESULTS 944 patients (mean age 72.82 years ± 8.13, 58% male) underwent aortic valve replacement with the Trifecta valve. At 10-years, 1.4% of patients required a redo operation, giving an overall freedom from re-intervention of 98.6%. The mean time to re-intervention was 48.87 months. Survival was 73.58% and 76.92% in patients who did not require re-intervention vs re-intervention group, respectively. CONCLUSIONS In a large, single-centre cohort, the Trifecta aortic bioprosthesis had a 1.4% all-cause re-intervention rate at 10-years, with insignificant impact on survival.
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Affiliation(s)
| | - Zahid Mahmood
- Golden Jubilee National Hospital, Clydebank, Scotland
| | | | | | - Nawwar Al-Attar
- University of Glasgow, Glasgow, UK; Golden Jubilee National Hospital, Clydebank, Scotland.
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25
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Lange R, Alalawi Z, Voss S, Boehm J, Krane M, Vitanova K. Different Rates of Bioprosthetic Aortic Valve Failure With Perimount™ and Trifecta™ Bioprostheses. Front Cardiovasc Med 2022; 8:822893. [PMID: 35127875 PMCID: PMC8811120 DOI: 10.3389/fcvm.2021.822893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe use of bioprostheses in surgical aortic valve replacement (SAVR) has increased in younger patients. Comparative analysis of different types of bioprostheses is lacking. We aimed to compare two proprietary bioprostheses with different designs, i.e., internally and externally mounted leaflets, focusing on the long-term durability and survival.MethodsWe conducted a large single-center retrospective analysis of all consecutive patients who underwent SAVR with either Perimount™ or Trifecta™ bioprostheses between 2001 and 2019. The patient groups were further subdivided by age <65 and >65. Endpoints of the study were all-cause mortality and reoperation due to bioprosthetic valve failure (BVF).ResultsSelection criteria resulted in a total sample of 5,053 patients; 2,630 received a Perimount prosthesis (internally mounted leaflets) and 2,423 received a Trifecta prosthesis (externally mounted leaflets). The mean age at surgery was similar (69 ± 11 y, PM, and 68 ± 10 y, TF, p = 0.9), as was estimated survival at 8 years (76.1 ± 1.3%, PM, and 63.7 ± 1.9% TF; p=0.133). Patients in the Trifecta group had a significantly higher cumulative reoperation rate at 8 years compared to those in the Perimount group (16.9 ± 1.9% vs. 3.8 ± 0.4%; p < 0.01). This difference persisted across age groups (<65 y, 13.3% TF vs. 8.6% PM; >65 y, 12% TF vs. 7% PM).ConclusionBioprostheses for SAVR with externally mounted leaflets (Trifecta) showed significantly higher long-term reoperation rates compared to those with internally mounted leaflets (Perimount), regardless of the patient's age at SAVR. Survival was similar with both bioprostheses.
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Affiliation(s)
- Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Insure (Institute of Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research)–Partner Site Munich Heart Alliance, Munich, Germany
| | - Zahra Alalawi
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Insure (Institute of Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Insure (Institute of Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Johannes Boehm
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Insure (Institute of Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Insure (Institute of Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research)–Partner Site Munich Heart Alliance, Munich, Germany
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Insure (Institute of Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- *Correspondence: Keti Vitanova
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Imai N, Kaminishi Y, Tsukada T, Osaka M, Sakamoto H, Mathis BJ, Suzuki Y, Hiramatsu Y. Two cases of catastrophic deterioration and multiple leaflet detachment in Trifecta valves. Gen Thorac Cardiovasc Surg 2022; 70:292-294. [PMID: 35038125 DOI: 10.1007/s11748-021-01749-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
Reports of early and catastrophic acute structural valve deterioration (SVD) in Trifecta valve (Abbott, St Paul, MN, USA) with multiple leaflet detachment are rare. We encountered two cases of early SVD in Trifecta valve with tears on two leaflets. Both cases presented with acute heart failure because of aortic insufficiency, and underwent redo aortic valve replacement; one patient died due to multiple organ failure caused by cardiogenic shock. Durability issues with the Trifecta valves; thus, necessitates long-term vigilance in aortic replacement patients.
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Affiliation(s)
- Nanami Imai
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuichiro Kaminishi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toru Tsukada
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Motoo Osaka
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Bryan James Mathis
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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27
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Porterie J, Salaun E, Ternacle J, Clavel MA, Dagenais F. Stress exercise haemodynamic performance and opening reserve of a stented bovine pericardial aortic valve bioprosthesis. J Card Surg 2022; 37:618-627. [PMID: 35020229 DOI: 10.1111/jocs.16220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite unusual high rates of patient-prosthesis mismatch (PPM), excellent midterm clinical outcomes have been reported after surgical aortic valve replacement (SAVR) with the Avalus™ bioprosthetic valve (Medtronic). To elucidate this "PPM conundrum," the Avalus valve haemodynamics were assessed during exercise testing. METHODS Of the 148 patients who had undergone SAVR with the Avalus valve at our institution, 30 were randomly selected among those in whom stress test was deemed feasible and underwent a resting transthoracic echocardiography immediately followed by exercise echocardiography. Severe PPM was defined as indexed effective orifice area (iEOA) ≤ 0.65 cm2 /m2 and moderate PPM as iEOA > 0.65 and ≤ 0.85 cm2 /m2 . Measured PPM was determined with the use of the measured iEOA at rest or stress, while the estimated PPM was based on the estimated iEOA, derived from the mean EOA reported for each valve size in the manufacturer chart. RESULTS Measured EOA significantly increased from rest to peak exercise in all PPM groups (p < .05) and the rates of moderate and severe measured PPM decreased from 40% and 20% to 27% and 0%, respectively. The patients with low-flow state (flow < 250 ml/s) had significantly lower measured rest EOA (p = .03). On the basis of the estimated iEOA, there was no severe PPM and 19 patients had moderate PPM (63.3%), with a significantly lower opening reserve than the patients without estimated PPM (p = .04). The estimated iEOA was more reliably correlated to the measured iEOA at maximal stress than the measured iEOA at rest, especially in patients with a low-flow state. CONCLUSIONS This study supports the concept of an opening reserve of the Avalus valve to explain the PPM conundrum and promotes the use of exercise Doppler-echocardiography to complete the assessment of mismatch, especially in patients with a low-flow state. Published estimated EOA seems reliable to predict the haemodynamic performance of the Avalus valve, whether the flow conditions at rest.
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Affiliation(s)
- Jean Porterie
- Department of Cardiac Surgery, Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Department of Clinical Research, Heart and Lung University Institute, Quebec City, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Julien Ternacle
- Department of Clinical Research, Heart and Lung University Institute, Quebec City, Quebec, Canada.,Department of Cardiology, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, France
| | - Marie-Annick Clavel
- Department of Clinical Research, Heart and Lung University Institute, Quebec City, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - François Dagenais
- Department of Cardiac Surgery, Heart and Lung University Institute, Quebec City, Quebec, Canada
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Bavaria JE, Griffith B, Heimansohn DA, Rozanski J, Johnston DR, Bartus K, Girardi LN, Beaver T, Takayama H, Mumtaz MA, Rosengart TK, Starnes V, Timek TA, Boateng P, Ryan W, Cornwell LD, Blackstone EH, Borger MA, Pibarot P, Thourani VH, Svensson LG, Puskas JD. Five-year Outcomes of the COMMENCE Trial Investigating Aortic Valve Replacement with RESILIA Tissue. Ann Thorac Surg 2022; 115:1429-1436. [DOI: 10.1016/j.athoracsur.2021.12.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
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29
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Structural Valvular Degeneration of Bioprosthetic Aortic Valves: A Network Meta-analysis. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00027-7. [DOI: 10.1016/j.jtcvs.2021.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
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30
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Errico K, Hui DS. Commentary: Wagering on Trifecta. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00105-2. [DOI: 10.1016/j.jtcvs.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
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Werner P, Coti I, Kaider A, Gritsch J, Mach M, Kocher A, Laufer G, Andreas M. Long-term durability after surgical aortic valve replacement with the Trifecta and the Intuity valve-a comparative analysis. Eur J Cardiothorac Surg 2021; 61:416-424. [PMID: 34738111 DOI: 10.1093/ejcts/ezab470] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Long-term durability of surgical bio-prostheses is a key factor, especially in the era of transcatheter aortic valve replacement. We compared the incidence of structural valve deterioration (SVD) between patients undergoing surgical aortic valve replacement (SAVR) with the Trifecta (Abbott Laboratories, Abbott Park, IL, USA) or the Intuity valve (Edwards Lifesciences, Irvine, CA, USA). METHODS Between April 2010 and May 2020, 1118 patients underwent SAVR with the Trifecta (n = 346) and the Intuity (n = 772) valve at a single centre. A total of 1070 patients (Trifecta n = 298, Intuity n = 772) were analysed after the exclusion of patients with pure regurgitation and endocarditis. Retro- and prospective echocardiographic and clinical follow-up was performed. Cox proportional hazards regression models were performed to identify prognostic factors for SVD, aortic re-interventions and mortality. RESULTS With 27 cases (Trifecta n = 23, Intuity n = 4) of SVD observed, cumulative incidence of SVD was significantly higher in the Trifecta cohort (P < 0.001). Implantation of a Trifecta valve [hazard ratio (HR) 11.20; 95% confidence interval 3.79-33.09], log-transformed preoperative creatinine (HR 2.47; 1.37-4.44) and sex (male HR 0.42; 0.19-0.92) emerged as prognostic factors of SVD. A significantly higher cumulative incidence of re-interventions was observed in the Trifecta cohort (P = 0.004) and valve type was an independent time-varying risk factor (HR at 12 months 2.78; 95% confidence interval 1.42-5.45). Overall, no significant differences in all-cause mortality were observed between the groups (log-rank test: P = 0.052). CONCLUSIONS SVD was significantly more frequent in patients receiving a Trifecta valve and its implantation was an independent risk factor for the occurrence of SVD and aortic valve re-interventions. This comparative analysis of 2 low-gradient bioprosthesis put the long-term durability of the Trifecta valve in question and need to be taken into consideration when performing bioprosthetic SAVR.
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Affiliation(s)
- Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Iuliana Coti
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Jasmin Gritsch
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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32
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Attia RQ, Raja SG. Surgical pericardial heart valves: 50 Years of evolution. Int J Surg 2021; 94:106121. [PMID: 34543742 DOI: 10.1016/j.ijsu.2021.106121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/10/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050. Since its genesis 50 years ago, pericardial heart valve has moved leaps and bounds to ever more ingenious designs and manufacturing methods with parallel developments in cardiology and cardiovascular surgical treatments. This feat has only been possible through close collaboration of many scientific disciplines in the fields of engineering, material sciences, basic tissue biology, medicine and surgery. As the pace of change continues to accelerate, we ask the readers to go back with us in time to understand developments in design and function of pericardial heart valves. This descriptive review seeks to focus on the qualities of pericardial heart valves, the advantages, successes and failures encapsulating the evolution of surgically implanted pericardial heart valves over the past five decades. We present the data on comparison of the pericardial heart valves to porcine valves, discuss structural valve deterioration and the future of heart valve treatments.
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Affiliation(s)
- Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, Uxbridge, London, UB9 6JH, United Kingdom
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33
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Hui DS. Commentary: Intuity - Not so Intuitive. Semin Thorac Cardiovasc Surg 2021; 34:465-466. [PMID: 34087374 DOI: 10.1053/j.semtcvs.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas.
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First there was a whisper; now there is a roar- We need to see the ten-year data. Ann Thorac Surg 2021; 112:1431-1432. [PMID: 33600793 DOI: 10.1016/j.athoracsur.2020.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
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35
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Meuris B, Rega F, Verbrugghe P. Perceval: the bottom line. Ann Thorac Surg 2021; 112:1382. [PMID: 33571496 DOI: 10.1016/j.athoracsur.2020.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Bart Meuris
- University Hospitals Leuven, Cardiac Surgery, Herestraat 49 3000, Leuven, Belgium.
| | - Filip Rega
- University Hospitals Leuven, Cardiac Surgery, Herestraat 49 3000, Leuven, Belgium
| | - Peter Verbrugghe
- University Hospitals Leuven, Cardiac Surgery, Herestraat 49 3000, Leuven, Belgium
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Damle S, Thourani VH. Surgical Valve Prosthesis Choices: Choose for the Now, But Don't Forget About the Future. Ann Thorac Surg 2020; 111:1206. [PMID: 33212027 DOI: 10.1016/j.athoracsur.2020.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sagar Damle
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, 95 Collier Rd, Ste 5015, Atlanta, GA 30309
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, 95 Collier Rd, Ste 5015, Atlanta, GA 30309.
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