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Hemodynamic Comparison Between Trifecta and Freestyle Aortic Valve During Exercise in Patients with Small Aortic Root
Author(s) -
Tasca Giordano,
Redaelli Paola,
Riva Beatrice,
Carlini Caterina Chiara De,
Lobiati Elisabetta,
Gamba Amando
Publication year - 2015
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12536
Subject(s) - medicine , hemodynamics , cardiac skeleton , cardiology , aortic valve , aortic valve replacement , prosthesis , surgery , stenosis
A bstract Background Patients with a small aortic annulus, that is ≤23 mm, constitute a challenge for the surgeon, because they are at high risk of patient‐prosthesis mismatch. Stentless valves provide better hemodynamic performance at rest and during exercise than stented valves, and are advocated in this group of patients. A new‐generation stented valve, the Trifecta (St. Jude), has recently become available with improved hemodynamics. The aim of this study was to compare the hemodynamic performance of Freestyle (Medtronic) and Trifecta at rest and during exercise in patients with a small aortic annulus. Methods From September 2012 to September 2014, 22 patients with a native aortic annulus ≤23 mm underwent ergometric stress testing one year after aortic valve replacement with either a Trifecta (12 patients) or a Freestyle (10 patients) bioprosthesis as part of a randomized study. Results The mean gradient at rest was 6.0 ± 2.3 mmHg for Trifecta and 4.3 ± 3.5 for Freestyle (p = 0.213). The mean gradient at peak of exercise was 9.7 ± 3.4 mmHg for Trifecta and 7.4 ± 5 mmHg for Freestyle (p = 0.243). No significant differences were found between the two prostheses regarding other hemodynamic parameters: effective orifice area, velocity index, and performance indexes. Conclusion Both the stented Trifecta and stentless Freestyle prostheses provide excellent hemodynamic results during physical stress in patients with a small aortic annulus. Our study confirms that Trifecta implantation results in low gradients at rest and during exercise and that the performance of Trifecta is similar to that of a stentless valve. doi: 10.1111/jocs.12536 (J Card Surg 2015;30:400–404)