Early failure of the Trifecta GT bioprostheses

Abstract

Early failure with cusp fracture was seen in patients with the newer-generation Trifecta GT valves, warranting further investigation.

Commentary: Early failure of the Trifecta GT bioprosthesis: Innovation is not always progress

“…The implant technique itself may have a major impact in the durability of prostheses with externally mounted leaflets, including oversizing, bending of the strut posts during hand-tying of sutures, or the use of suture-tying devices with rigid knot stabilizers. Although oversizing was unlikely to play a significant role in the SVD reported by Tchouta and colleagues, 3 2 of the 3 patients required an aortic annulus enlargement, and the third was a female with small body surface area and aortic root diameter, suggesting anatomical conditions likely to favor strut distortion during implantation.…”

“…In summary, the findings by Tchouta and colleagues 3 are concerning, especially given the current trend of extending bioprosthetic AVR to younger patients. Well-designed, multicenter studies are urgently needed to elucidate all possible mechanisms of early SVD, to allow for a fine-tuning of the surgical implant, and optimal selection of the appropriate prosthesis for each individual patient.…”

“…Well-designed, multicenter studies are urgently needed to elucidate all possible mechanisms of early SVD, to allow for a fine-tuning of the surgical implant, and optimal selection of the appropriate prosthesis for each individual patient. The report by Tchouta and colleagues 3 further highlights the fact that close longitudinal echocardiographic surveillance becomes paramount in an era in which the treatment of severe aortic stenosis is rapidly evolving.…”

“…In this issue of the Journal , Tchouta and colleagues 3 reported 3 cases of early SVD after AVR with the Trifecta GT, for a cumulative incidence of 3.3% at 3.5 years among a population of 106 patients. Mean age at implantation was 56.7 years and all 3 patients had bicuspid aortic valve.…”

“…The report by Tchouta and colleagues 3 suggests that biologic/immunologic factors may be less relevant in early SVD, whereas the mechanical/fluid dynamic properties directly associated with particular elements of the prosthetic valve design may be more important contributing factors. 2 , 4 No prosthetic leaflet calcification was observed in any of the 3 cases.…”