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.