Patient-prosthesis Mismatch Rates In Magna Ease Versus Trifecta Bioprosthetic Aortic Valves: Analysis Of Single-center Surgical Data
Aurinjoy Gupta, BSc1, Hashem Aliter, MD2, Chris Theriault, Prof Eng3, Edgar Chedrawy, MD2.
1Northern Ontario School of Medicine, Thunder Bay, ON, Canada, 2Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada, 3Research Methods Unit, Nova Scotia Health Authority, Halifax, NS, Canada.
OBJECTIVE: Many patients undergoing surgical aortic valve replacement (SAVR) experience patient-prosthesis mismatch (PPM). The SJ Trifecta valve boasts larger effective orifice areas (EOAs) due to its supra-annular design, with the goal to lower rates of PPM. We analyzed the use of CE Pericardial valves versus Trifecta valves at our center and measured the incidence of PPM and reoperation.
METHODS: Patients undergoing SAVR at our center between 2006 and 2016 were recruited. PPM status was calculated from prosthetic valve reference EOAs and patient body surface area, and PPM was defined as an EOA index less than 0.85 cm2/m2. Logistic regression was used to analyze associations between valve type and PPM rates, and Cox regression was used to analyze reoperation rates. Primary endpoints were PPM at time of SAVR and reoperation within the study period.
RESULTS: Our SAVR database contained 1943 SAVR patients that fit our inclusion criteria. In this population, 1438 CE Pericardial valves and 505 Trifecta valves were implanted. CE Pericardial and Trifecta groups had comparable age, sex, and BMI profiles. Trifecta valves were associated with the absence of PPM (OR=0.011, p<0.00001). In surgeries where Trifecta valves were implanted, 81.8% of patients had no PPM, compared to 31.2% among CE Pericardial valve recipients (p<0.001). Reoperation rates were comparable at the end of the study period, however, Cox regression showed association of the Trifecta valve with earlier reoperation (HR=3.60, p<0.005), independent of valve size, smoking, age, BMI, and sex.
CONCLUSIONS: The Trifecta valve was associated with lower incidence of PPM and in-hospital mortality in our cohort. However, Trifecta valves were also associated with earlier reoperation. We recommend that the risks of PPM be appropriately balanced with the benefits of longer valve lifespan when choosing between CE Pericardial and Trifecta aortic valve prostheses.
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