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Durability and clinical experience using a bovine pericardial prosthetic aortic valve
Authors:Sven Lehmann  Khalil Jawad  Maja T. Dieterlen  Alexandro Hoyer  Jens Garbade  Piroze Davierwala  Michael A. Borger
Affiliation:1. University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany;2. Peter Munk Cardiac Center, Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada;1. Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill;2. Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, Ill;1. Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio;2. Cardiac Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom;1. Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden;2. Department of Surgery, Bayhealth Medical Center, Dover, Del;3. Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden;4. Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden;1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa;2. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa;3. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich;4. Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla;5. Cardiac Surgery Department, University of Bologna, Bologna, Italy;6. Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga;7. Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass;8. Division of Cardiology, Robert-Bosch Krankenhaus, Stuttgart, Germany;9. Cardiovascular Center, University of Michigan, Ann Arbor, Mich;10. Department of Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy;1. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa;2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pa;1. Cardiac Surgery Center, Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China;2. Beijing Institute of Heart Lung and Vascular Disease, Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China
Abstract:
ObjectivesTo report the implant experience and long-term outcomes from a large tertiary care referral center on surgical aortic valve replacement (SAVR) with a contemporary stented pericardial bioprosthesis with anticalcification treatment.MethodsPatients underwent SAVR using the Trifecta valve at a single institution. Endpoints included procedural outcomes, adverse events, prosthesis–patient mismatch (PPM), long-term survival, and valve durability. Follow-up included 30-day, 6-month, and annual assessments. Treatment for structural valve deterioration (SVD) included surgical explant and valve-in-valve (V-in-V) transcatheter aortic valve implantation (TAVI).ResultsSAVR was performed in 1241 patients (median age, 73.5 ± 6.4 years; 54% male; median logistic EuroSCORE, 7.8) with concomitant procedures in 713 cases (57.5%). Intraprocedural mortality was 1.4%, and 30-day mortality was 6.0%. At hospital discharge, 68 patients (5.5%) had moderate PPM, and no patients had severe PPM. Adverse events included cardiac arrhythmias (44.7%, mostly atrial fibrillation), respiratory failure (22.9%), acute renal failure requiring temporary renal replacement therapy (12.9%), and low cardiac output syndrome (3.3%). Follow-up data were available over a total of 5469 patient-years (median duration of follow-up, 4.7 years). Freedom at 8 years from all-cause mortality, valve-related mortality, reoperation for SVD (redo SAVR or V-in-V TAVI), and endocarditis were 78.4%, 98.0%, 93.3%, and 96.5%, respectively. Of the 30 patients with SVD, 17 were treated by V-in-V TAVI and 13 underwent surgical explant.ConclusionsOutcomes from this large single-center cohort at increased surgical risk demonstrate excellent long-term durability of the Trifecta valve for SAVR and feasibility of treating SVD by V-in-V TAVI.
Keywords:Trifecta  structural valve deterioration  prosthesis-patient mismatch  CEP"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0020"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Carpentier–Edwards Perimount  EOA"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0030"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  effective orifice area  IQR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0040"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  interquartile range  PPM"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0050"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  prosthesis–patient mismatch  SAVR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0060"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  surgical aortic valve replacement  SVD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0070"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  structural valve deterioration  TAVI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0080"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  transcatheter aortic valve implantation  V-in-V"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0090"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  valve-in-valve
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