Abstract
Medium-term results and the impact of structural valve deterioration of Trifecta versus Perceval bioprostheses: analysis from the Perfecta study
- Cardiac Surgery Division, Department of Surgical Sciences Tor Vergata University of Rome, Italy
- Cardiology Unit of the Cardiac Surgery Division, Tor Vergata University of Rome, Tor Vergata University Polyclinic, Rome, Italy
- Cardiac-Thoracic Anesthesia Division, Tor Vergata University of Rome, Tor Vergata University Polyclinic, Rome, Italy
Introduction
Surgical aortic valve replacement remains the most effective treatment for severe aortic valve disease, thanks to the evolution and development of new-generation biological prostheses.
Aim
The study aimed to compare the follow-up results of aortic valve replacement with implantation of the Perceval sutureless bioprosthesis and St. Jude Trifecta sutured bioprosthesis (the single-center Perfecta study), evaluating the following end-points: survival, event-free survival rates, and impact of structural valve deterioration (SVD) on freedom from reintervention.
Material and methods
etween December 2014 and June 2023, 280 patients underwent aortic valve replacement with Trifecta (n = 220; mean age: 75.2 ±6.5 years) and Perceval implantation (n = 60; mean age: 77.9 ±5.1 years); 274 survivors (Trifecta = 214, Perceval = 60) were followed.
Results
At 7 years for both bioprostheses, Trifecta vs.Perceval, survival (68 ±4.1% vs. 89 ±4.8%; p = 0.19), freedom from cardiac death (90 ±2.3% vs. 94 ±1.7%; p = 0.38), from endocarditis (96 ±1.4% vs. 94 ±3.0%; p = 0.99) and from reintervention (98 ±1.4% vs. 100%; p = 0.13) were similar. SVD was observed in 60 Trifecta implants – 53 of which were in the initial stages – and in one in Perceval implant. Freedom from overall SVD was 74 ±4.2% vs. 93 ±6.4% (p = 0.09). Moderate patient-prosthesis mismatch was more frequently observed in the Trifecta than the Perceval group (n = 38 [17.3%] vs. n = 5 [8.2%]; p = 0.004). Independent predictors of SVD, both in the initial stages and overall, were Trifecta implantation (HRs 20.5;22.4) and moderate PPM (HRs 2.5;2.3). NYHA class (I–II 79.6% and 98.3% vs. 46.3% and 40%) significantly improved compared to preoperatively in both groups (p < 0.001).
Conclusions
Both bioprostheses appear to confer equally satisfactory late outcomes. Although the Trifecta prosthesis carries a higher risk of SVD, this risk does not seem to be significantly associated with worse clinical conditions or need for reoperation. The Perceval prosthesis can be considered a viable option in the context of the latest-generation bioprostheses.
>Keywords
surgical aortic valve replacement, sutureless prostheses, third-generation sutured biological prostheses, structural valve deterioration
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