Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement
<b>Aims of the Study:</b> We evaluated the clinical outcome and the hemodynamic and freedom from structural valve degeneration of two standard aortic bioprostheses. <b>Methods:</b> Clinical results, echocardiographic findings and follow-up data of patients operated for isolat...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/4/139 |
| _version_ | 1797604975492202496 |
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| author | Francesca Toto Laura Leo Catherine Klersy Tiziano Torre Thomas Theologou Alberto Pozzoli Elena Caporali Stefanos Demertzis Enrico Ferrari |
| author_facet | Francesca Toto Laura Leo Catherine Klersy Tiziano Torre Thomas Theologou Alberto Pozzoli Elena Caporali Stefanos Demertzis Enrico Ferrari |
| author_sort | Francesca Toto |
| collection | DOAJ |
| description | <b>Aims of the Study:</b> We evaluated the clinical outcome and the hemodynamic and freedom from structural valve degeneration of two standard aortic bioprostheses. <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> = 0.120). Perimount patients presented a greater body mass index (27.6 ± 4.5 vs. 26.0 ± 4.2; <i>p</i> = 0.022), and 23% of them suffered from angina functional class 2–3 (23.2% vs. 5.8%; <i>p</i> = 0.002). Mean ejection fraction was 53.7 ± 11.9% (Trifecta) and 54.5 ± 10.4% (Perimount) (<i>p</i> = 0.994), with mean gradients of 40.4 ± 15.9 mmHg (Trifecta) and 42.3 ± 20.6 mmHg (Perimount) (<i>p</i> = 0.710). Mean EuroSCORE-II was 7 ± 11% and 6 ± 9% for the Trifecta and Perimount group, respectively (<i>p</i> = 0.553). Trifecta patients more often underwent isolated aortic valve replacement (45.3% vs. 26.8%; <i>p</i> = 0.016) and annulus enlargement (10.5% vs. 2.4%; <i>p</i> = 0.058). All-cause mortality at 30 days was 3.5% (Trifecta) and 8.5% (Perimount), (<i>p</i> = 0.203) while new pacemaker implantation (1.2% vs. 2.5%; <i>p</i> = 0.609) and stroke rate (1.2% vs. 2.5%; <i>p</i> = 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; <i>p</i> = 0.196) and a weighted OR of 1.10 (95%CI: 0.44–2.76, <i>p</i> = 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; <i>p</i> = 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; <i>p</i> = 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; <i>p</i> = 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; <i>p</i> < 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; <i>p</i> = 0.224); <b>Conclusions:</b> 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. |
| first_indexed | 2024-03-11T04:54:30Z |
| format | Article |
| id | doaj.art-df792465f3b346558023ce7762f81b75 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T04:54:30Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-df792465f3b346558023ce7762f81b752023-11-17T19:47:22ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-03-0110413910.3390/jcdd10040139Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve ReplacementFrancesca Toto0Laura Leo1Catherine Klersy2Tiziano Torre3Thomas Theologou4Alberto Pozzoli5Elena Caporali6Stefanos Demertzis7Enrico Ferrari8Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandDepartment of Cardiology, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandService of Clinical Epidemiology & Biometry, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, ItalyCardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandCardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandCardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandDepartment of Cardiology, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandCardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, SwitzerlandCardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland<b>Aims of the Study:</b> We evaluated the clinical outcome and the hemodynamic and freedom from structural valve degeneration of two standard aortic bioprostheses. <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> = 0.120). Perimount patients presented a greater body mass index (27.6 ± 4.5 vs. 26.0 ± 4.2; <i>p</i> = 0.022), and 23% of them suffered from angina functional class 2–3 (23.2% vs. 5.8%; <i>p</i> = 0.002). Mean ejection fraction was 53.7 ± 11.9% (Trifecta) and 54.5 ± 10.4% (Perimount) (<i>p</i> = 0.994), with mean gradients of 40.4 ± 15.9 mmHg (Trifecta) and 42.3 ± 20.6 mmHg (Perimount) (<i>p</i> = 0.710). Mean EuroSCORE-II was 7 ± 11% and 6 ± 9% for the Trifecta and Perimount group, respectively (<i>p</i> = 0.553). Trifecta patients more often underwent isolated aortic valve replacement (45.3% vs. 26.8%; <i>p</i> = 0.016) and annulus enlargement (10.5% vs. 2.4%; <i>p</i> = 0.058). All-cause mortality at 30 days was 3.5% (Trifecta) and 8.5% (Perimount), (<i>p</i> = 0.203) while new pacemaker implantation (1.2% vs. 2.5%; <i>p</i> = 0.609) and stroke rate (1.2% vs. 2.5%; <i>p</i> = 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; <i>p</i> = 0.196) and a weighted OR of 1.10 (95%CI: 0.44–2.76, <i>p</i> = 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; <i>p</i> = 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; <i>p</i> = 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; <i>p</i> = 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; <i>p</i> < 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; <i>p</i> = 0.224); <b>Conclusions:</b> 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.https://www.mdpi.com/2308-3425/10/4/139aortic valve prosthesisaortic valve replacementPerimount bioprosthesisTrifecta bioprosthesis |
| spellingShingle | Francesca Toto Laura Leo Catherine Klersy Tiziano Torre Thomas Theologou Alberto Pozzoli Elena Caporali Stefanos Demertzis Enrico Ferrari Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement Journal of Cardiovascular Development and Disease aortic valve prosthesis aortic valve replacement Perimount bioprosthesis Trifecta bioprosthesis |
| title | Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement |
| title_full | Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement |
| title_fullStr | Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement |
| title_full_unstemmed | Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement |
| title_short | Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement |
| title_sort | mid term clinical outcomes and hemodynamic performances of trifecta and perimount bioprostheses following aortic valve replacement |
| topic | aortic valve prosthesis aortic valve replacement Perimount bioprosthesis Trifecta bioprosthesis |
| url | https://www.mdpi.com/2308-3425/10/4/139 |
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