Pulmonary Valve Replacement With a Trifecta Valve Is Associated With Reduced Transvalvular Gradient

Abstract

Background Outcomes after surgical pulmonary valve replacement (PVR) in patients with congenital cardiac disease are limited by long-term valve deterioration, which may be hastened by turbulent flow. The use of the Trifecta valve (St. Jude Medical, Little Canada, MN) at our institution (Duke University Medical Center, Durham, NC) appears to result in low postimplantation transvalvular gradients. This study was performed to compare the early transvalvular gradient associated with the Trifecta valve with that associated with two other valves commonly used for PVR. Methods We performed a single institution review of patients undergoing PVR with the Perimount valve (Edwards Lifesciences, Irvine, CA), the Biocor valve (St. Jude Medical), or the Trifecta valve between November 1993 and January 2014. Multivariable linear regression modeling was used to determine the adjusted association between valve type and transvalvular gradient as determined by early postoperative echocardiography. Results A total of 186 patients met study criteria; 54 (29%) received a Biocor valve, 87 (47%) received a Perimount valve, and 45 (24%) received a Trifecta valve. There were no baseline differences among the groups, but the peak transvalvular gradient was significantly decreased among patients with the Trifecta valve. After adjustment for age, valve size, patients’ weight, and time to the assessment, as compared with the Trifecta valve, the Biocor valve was associated with a 57% higher peak valve gradient (p < 0.01), whereas the Perimount valve was associated with a 26% higher peak valve gradient (p = 0.04). Conclusions PVR for congenital heart disease with the Trifecta bioprosthetic valve is associated with a reduced early transvalvular gradient. This finding may be associated with reduced valve deterioration over time.

Trifecta St. Jude medical® aortic valve in pulmonary position

“…In fact this favourable effective orifice area has been recently shown to provide a lower transvalvular pressure gradient across the Trifecta St. Jude Medical® aortic valve implanted in PV position in comparison with other biological prostheses,[44,45] and this further validated our choice of this type of valve, without need for any modification for implant in pulmonary valve position.…”

“…We decided to use the Trifecta St. Jude Medical® aortic valve instead of the other biological prostheses available because of several reasons: (a) the very good results obtained in aortic position, therefore with exposure to a much higher systolic and diastolic pressures, in long-term follow-up;[44–46] (b) the structure of the valve, with posts totally covered by pericardium, reducing the risk of embolism and haemolysis; (c) the availability in various sizes, compatible even for patients of large body weight.…”

Development of Tissue Engineered Heart Valves for Percutaneous Transcatheter Delivery in a Fetal Ovine Model

“…Although no true control valve of similar size is available for comparison, the peak PG reported for the TEHV was 20 mm Hg, while peak PGs reported in children receiving a Melody valve (Medtronic, Minneapolis, Minnesota) or SAPIEN valve (Edwards Lifesciences, Irvine, California) in pulmonary conduits were 13.5 mm Hg (by catheterization at time of implant) and 18.7 mm Hg (by echocardiogram at 1-month follow-up), respectively ( 34 , 35 , 36 ). Postoperative pressure gradients of surgical valves implanted in the pulmonary position in pediatric patients (determined by echocardiogram) were reported as 16 to 44 mm Hg ( 37 ). The EOA was found to be 35.4% of the available geometric area of the valve.…”

Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All

“…The Trifecta® (Abbott, Abbott Park, Illinois, USA) valve, tri-leaflet stented pericardial valve designed for implantation in aortic position, with a supra-annular sewing cuff, pericardial-covered posts, pericardial leaflets taking origin from the exterior of the valve construct, increasing the effective orifice area for any external diameter, provided good results in PV position ( 51 , 52 ).…”