Hemodynamic comparison between Trifecta and freestyle aortic valve during exercise in patients with small aortic root

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Medical Devices

Background:

• Small aortic annuli (≤ 23 mm) pose a risk of patient-prosthesis mismatch.
• Stentless valves are traditionally preferred for their hemodynamic performance in these patients.
• A new-generation stented valve, the Trifecta, offers improved hemodynamics.

Purpose of the Study:

• To compare the hemodynamic performance of the Trifecta stented valve and the Freestyle stentless valve.
• To evaluate performance at rest and during exercise in patients with small aortic annuli.
• To assess the suitability of the Trifecta valve for patients at risk of patient-prosthesis mismatch.

Main Methods:

• A randomized study involving 22 patients with native aortic annulus ≤ 23 mm.
• Ergometric stress testing was performed one year post-aortic valve replacement.
• Patients received either the Trifecta (12) or Freestyle (10) bioprosthesis.

Main Results:

• No significant difference in mean gradient at rest (Trifecta: 6.0 ± 2.3 mmHg vs. Freestyle: 4.3 ± 3.5 mmHg).
• No significant difference in mean gradient at peak exercise (Trifecta: 9.7 ± 3.4 mmHg vs. Freestyle: 7.4 ± 5 mmHg).
• Similar hemodynamic parameters including effective orifice area and velocity index between the two valves.

Conclusions:

• Both Trifecta stented and Freestyle stentless valves demonstrate excellent hemodynamic results in patients with small aortic annuli.
• The Trifecta valve exhibits low gradients at rest and during exercise.
• The hemodynamic performance of the Trifecta valve is comparable to that of a stentless valve in this patient cohort.