Trifecta vs. Magna for Aortic Valve Replacement　― Differences in Clinical Outcome and Valve Hemodynamics ―

Tadokoro, Naoki; Fukushima, Satsuki; Shimahara, Yusuke; Matsumoto, Yorihiko; Yamashita, Kizuku; Kawamoto, Naonori; Minami, Kimito; Kobayashi, Junjiro; Fujita, Tomoyuki

doi:10.1253/circj.cj-18-0744

Cited by 20 publications

(22 citation statements)

References 17 publications

(11 reference statements)

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“…Tadokoro et al showed that the early hemodynamic advantage of the Trifecta valve lasted for up to 1 year postoperatively. Thereafter, this difference diminished gradually over time [14]. These results are partially consistent with our findings, showing that the differences in the TVPG between the two groups did not change over time, with the only exception being the time immediately after surgery.…”

Section: Discussionsupporting

confidence: 91%

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

Kim

Lee

Joo

et al. 2021

JCM

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The Trifecta valve has externally mounted leaflets; it differs from classic internally mounted valves (e.g., Carpentier-Edwards [C-E]). We evaluated post-implantation hemodynamics and clinical outcomes of these bioprostheses in small aortic annuli. From January 2015 to April 2019, 490 patients who underwent aortic valve replacement (AVR) were reviewed retrospectively. Altogether, 183 patients received 19 or 21 mm diameter C-E (n = 121) or Trifecta (n = 62) prostheses. To minimize confounding variables, we performed propensity-score matching analysis. The mean transvalvular pressure gradient (TVPG) was significantly lower in the Trifecta than in the C-E group at discharge (12.9 ± 4.8 vs. 15.0 ± 5.3 mmHg, p = 0.044). TVPG change over time was not significantly different between groups (p = 0.357). Left ventricular mass index decreased postoperatively (reduction: C-E, 28.1%; Trifecta, 30.1%, p = 0.879). No late mortality, severe patient–prosthesis mismatch, moderate-to-severe paravalvular leakage, structural valve degeneration, or valve thromboses were observed. Freedom from valve-related events at 3 years were similar for C-E (97.9% ± 2.1%) and Trifecta (97.7% ± 2.2%) patients (log-rank p = 0.993). Bioprosthesis design for small annuli significantly affected TVPG immediately after AVR. However, hemodynamics over time and clinical outcomes did not differ between the two designs.

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Section: Discussionsupporting

confidence: 91%

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

Kim

Lee

Joo

et al. 2021

JCM

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“…Interestingly, the authors have shown much higher late postoperative gradients in the smaller valve sizes with the 19-mm Trifecta having increased mean gradients to 18 mm Hg starting at 6 months postoperatively. This is similar to reported results in competing stented tissue valves [3]. Although the Trifecta's unique design can improve hemodynamics (early anyway), it creates a new problem with our TAVR mindset.…”

Section: Invited Commentarysupporting

confidence: 85%

Invited Commentary

Shah

2019

The Annals of Thoracic Surgery

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“…In addition, we did not randomise the prosthetic valve selection (Avalus™ or other valves) in this study; instead, the valves were selected by individual surgeons who implanted the best-matched valve prosthesis for each patient. Because the Avalus™ valve was the primary choice of bioprosthetic valve during the study period, the study bias related to patient selection was minimal [14,15].…”

Section: Discussionmentioning

confidence: 99%

Comparison of safety and haemodynamic performance between the Avalus™ stented aortic valve bioprosthesis and Magna™ valve in Japanese patients

Tadokoro

Fukushima

Shimahara

et al. 2021

Gen Thorac Cardiovasc Surg

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Objectives A new stented bovine pericardial valve (Avalus™) has been proven safe and effective with good hemodynamic performance in Western populations. However, its use in Japanese patients is poorly understood. We retrospectively compared the feasibility, safety, and valve haemodynamics between the Avalus™ and Magna™ valves in patients who underwent surgical aortic valve replacement (SAVR). Methods This study included 87 patients receiving an Avalus™ valve and 387 receiving a Magna™ valve. We evaluated adverse events, outcomes, and valve haemodynamics within 1 year postoperatively. There were no significant differences in any surgical risk scores. Results No in-hospital mortality occurred in the Avalus™ group, but two mortality events occurred in the Magna™ group. No pacemaker implantation for complete atrioventricular block was required in the Avalus™ group. There was no significant difference in in-hospital or clinical outcomes between the two groups until 1 year postoperatively. Left ventricular mass index reduction appeared to predominate in the Avalus™ over Magna™ group. There was no significant difference in the mean pressure gradient or effective orifice area of each valve size at 1 week or 1 year between the two groups, apart from the mean pressure gradient of the 23-mm valve at 1 week. Three patients (3.4%) in the Avalus™ group and 39 (10.8%) in the Magna™ group (p = 0.12) had severe patient–prosthesis mismatch at 1 week postoperatively. Conclusions The new Avalus™ stented aortic valve bioprosthesis was associated with good in-hospital outcomes and good valve functionality post-SAVR in Japanese patients.

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Trifecta vs. Magna for Aortic Valve Replacement　― Differences in Clinical Outcome and Valve Hemodynamics ―

Abstract: Postoperative outcomes were similar for both valves. An early hemodynamic advantage for the Trifecta valve lasted to approximately 1 year postoperatively but did not persist.

Cited by 20 publications

References 17 publications

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

Invited Commentary

Comparison of safety and haemodynamic performance between the Avalus™ stented aortic valve bioprosthesis and Magna™ valve in Japanese patients

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Trifecta vs. Magna for Aortic Valve Replacement ― Differences in Clinical Outcome and Valve Hemodynamics ―

Abstract: Postoperative outcomes were similar for both valves. An early hemodynamic advantage for the Trifecta valve lasted to approximately 1 year postoperatively but did not persist.

Cited by 20 publications

References 17 publications

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

Invited Commentary

Comparison of safety and haemodynamic performance between the Avalus™ stented aortic valve bioprosthesis and Magna™ valve in Japanese patients

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Product

Resources

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Trifecta vs. Magna for Aortic Valve Replacement　― Differences in Clinical Outcome and Valve Hemodynamics ―