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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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Hashem AM, Elkhapery A, Mohamed A, Buttar R, Khalouf A, Mohamed MS, Abbas F, Rehman SU, Eisa M, Baibhav B, Rai D, Depta JP. Rates and Predictors of Structural Valve Degeneration and Failure of Trifecta Bioprosthetic Valve Over a 5-year Follow-up Period: A Single-center Experience. J Cardiovasc Echogr 2024; 34:7-13. [PMID: 38818315 PMCID: PMC11135815 DOI: 10.4103/jcecho.jcecho_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction The Trifecta bioprosthetic valve has been commonly used for surgical aortic valve replacement (SAVR). Multiple studies have been done to define the rate of structural valve degeneration (SVD) and failure (SVF), but the outcomes are still debatable. Therefore, we aim to conduct this single-center study to estimate the rate and predictors of SVD/SVF. Methodology This retrospective observational cohort single-center study was conducted between 2014 and 2019 among Trifecta SAVR patients. Data were patient's characteristics collected from electronic medical records at baseline and follow-up (3-5 years). Statistical analysis was performed with a significance level of P ≤ 0.05. Results A total of 271 eligible patients were identified. Most of our sample were males (57.9%), with a mean age of 71.1 ± 10.6 years. The mean baseline preoperative ejection fraction (EF) was 53.0%, with no change (P = 0.88) in the immediate postoperative EF (53.6%). A most recent follow-up EF revealed a significant increase of EF (55.2%), P = 0.01. Furthermore, there was a significant increase from peak velocity to PVMRE (mean difference [MD] ± standard error of mean (SEM) [0.15 ± 0.04], P < 0.01), an increase in pressure gradient (PGIPE) to PGMRE (MD ± SEM [1.70 ± 0.49], P < 0.01), and a decrease in Doppler velocity index (DVIIPE) to DVIMRE (MD ± SEM [-0.037 ± 0.01], P = 0.01). Regarding the SVF rate, 13 (4.8%) patients had failed valves requiring replacement throughout the study period. Conclusions Over a 5-year follow-up period, 4.8% had SVF with an SVD of 23.2%, with the majority of SVD not being clinically significant except in six patients. These results corroborate with a previously published study suggesting a bad clinical outcome of Trifecta valve placement.
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Affiliation(s)
- Anas Mohamad Hashem
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Ahmed Elkhapery
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amr Mohamed
- Department of Cardiovascular, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Rupinder Buttar
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amani Khalouf
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | | | - Faiz Abbas
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
| | - Saif ur Rehman
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Mahmoud Eisa
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Bipul Baibhav
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
| | - Devesh Rai
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
| | - Jeremiah P. Depta
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
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Montero Cruces L, Carnero Alcázar M, Pérez Camargo D, Cobiella Carnicer J, Campelos Fernández P, Reguillo Lacruz FJ, Maroto Castellanos LC. 5-Year haemodynamic performance of three aortic bioprostheses. A randomized clinical trial. Eur J Cardiothorac Surg 2023; 64:ezad261. [PMID: 37471587 DOI: 10.1093/ejcts/ezad261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES The Carpentier Perimount (CP) Magna Ease, the Crown Phospholipid Reduction Treatment (PRT) and the Trifecta bovine pericardial valves have been widely used worldwide. The primary end point of this study was to compare the haemodynamic performance quantified by in vivo echocardiograms of these 3 aortic prostheses. METHODS The "BEST-VALVE" (comparison of 3 contemporary cardiac bioprostheses: mid-term valve haemodynamic performance) was a single-centre randomized clinical trial to compare the haemodynamic and clinical outcomes of the aforementioned bioprostheses. The 5-year results are assessed in this manuscript. RESULTS A total of 154 patients were included. The CP Magna Ease (n = 48, 31.2%), Crown PRT (n = 51, 32.1%) and Trifecta (n = 55, 35.7%) valves were compared. Significant differences were observed among the 3 bioprostheses 5 years after the procedure. The following haemodynamic differences were found between the CP Magna Ease and the Crown PRT bioprostheses [mean aortic gradient: 12.3 mmHg (interquartile range {IQR} 7.8-17.5) for the CP Magna Ease vs 15 mmHg (IQR 10.8-31.9) for the Crown PRT, P < 0.001] and between the CP Magna Ease and the Trifecta prostheses [mean aortic gradient: 12.3 mmHg (IQR 7.8-17.5) for the CP Magna Ease vs 14.7 mmHg (IQR 8.2-55) for the Trifecta, P < 0.001], with a better haemodynamic performance of the CP Magna Ease. The cumulative incidence of severe structural valve degeneration was 9.5% in the Trifecta group at 6 years of follow-up. The 1-, 3- and 5-year survival from all-cause mortality was 91.5%, 83.5% and 74.8%, respectively (log rank P = 0.440). Survival from the composite event at the 1-, 3- and 5-year follow-up was 92.8%, 74.6% and 59%, respectively (log rank P = 0.299). CONCLUSIONS We detected significant differences between the 3 bioprostheses; the CP Magna Ease had the best haemodynamic performance at the 5-year follow-up.
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Affiliation(s)
| | | | - Daniel Pérez Camargo
- Department of Cardiovascular Surgery, Clínico San Carlos Hospital, Madrid, Spain
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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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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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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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Hassanabad AF, Ahsan MR, Hibino M. Valve deterioration: A victim of construct over time? J Card Surg 2022; 37:1230-1232. [DOI: 10.1111/jocs.16325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ali F. Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences Libin Cardiovascular Institute, Cumming School of Medicine Calgary Alberta Canada
| | - Muhammad R. Ahsan
- Section of Cardiac Surgery, Department of Cardiac Sciences Libin Cardiovascular Institute, Cumming School of Medicine Calgary Alberta Canada
| | - Makoto Hibino
- Department of Cardiac Surgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
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