Introduction
Native aortic valves are increasingly replaced with bioprosthetic valves
in surgical aortic valve replacement (AVR).1 The
nature of the bioprosthetic valve design falls susceptible to structural
valve deterioration (SVD), but durability has been improving with new
designs.2,3 The multitude of brands on the market
elicits the need to compare prosthesis durabilities and rates of
reoperation.
The Carpentier-Edwards Perimount (Edwards Lifesciences, Irvine, CA, USA)
and the St. Jude Medical Trifecta valve (St. Jude Medical, St. Paul, MN,
USA; recently acquired by Abbott, Illinois, USA) are two popular
options.4 Perimount has been a frequent choice in our
centre because it has a proven track record of good
durability,5 low incidence of
PPM,5,6 and rates of survival and valve-related
complications comparable to other valves.6 The Magna
Ease valve is the newest iteration of the Perimount design that received
modifications to increase the ease of implantation, including a smaller,
contoured sewing ring than previous iterations.6 The
Manga Ease has demonstrated a hemodynamic performance comparable to its
predecessor at early timepoints.7,8 The Trifecta is a
newer valve, introduced in our center in 2011. The Trifecta is also
implanted in the supra-annular position to generate maximal leaflet
opening and hemodynamics similar to a stentless
valve.9,10 Trifecta has been compared to Magna Ease at
early timepoints to show Trifecta having a slight edge in terms of
post-operative hemodynamic parameters: lower mean gradient, lower
maximum velocity, and larger orifice size at rest and during
exercise.9,11–15 At early time points, Trifecta also
has been reported to have lower rates of severe PPM,13comparable or slightly lower rates of mortality and congestive heart
failure,15,16 and comparable SVD rates in large series
implantation studies.10,17
Published data at early time points supports the continued use of both
Perimount and Trifecta valves, however, midterm data for Trifecta is
still sparse. One recent study of mid-term valve durability has
demonstrated that Trifecta is associated with a higher occurrence of
reoperation due to SVD compared to the Perimount Magna
Ease.4 Given the sparseness of midterm outcomes of
Trifecta, this study aims to compare Trifecta to the Perimount valve, to
confirm that low reoperation rates of Trifecta persist over time.