Pulmonary Valve Replacement With a Trifecta Valve Is Associated With Reduced Transvalvular Gradient

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Congenital Heart Disease Research

Background:

• Pulmonary valve replacement (PVR) outcomes in congenital heart disease are limited by long-term valve deterioration.
• Turbulent blood flow may accelerate valve deterioration after PVR.
• The Trifecta valve has shown promise for low postimplantation transvalvular gradients.

Purpose of the Study:

• To compare early transvalvular gradients of the Trifecta valve with other commonly used valves for PVR.
• To evaluate the hemodynamic performance of different bioprosthetic valves in PVR.
• To identify valves associated with lower transvalvular gradients in congenital cardiac disease patients.

Main Methods:

• Single institution review of 186 patients undergoing PVR between 1993 and 2014.
• Comparison of Perimount, Biocor, and Trifecta valves.
• Multivariable linear regression analysis to adjust for patient and valve characteristics.

Main Results:

• The Trifecta valve group (n=45) demonstrated a significantly decreased peak transvalvular gradient compared to Biocor (n=54) and Perimount (n=87) valves.
• After adjustment, Biocor valves showed a 57% higher gradient (p < 0.01) and Perimount valves showed a 26% higher gradient (p = 0.04) versus Trifecta.
• No baseline differences were observed among the valve groups.

Conclusions:

• Pulmonary valve replacement with the Trifecta bioprosthetic valve is associated with a reduced early transvalvular gradient.
• Lower transvalvular gradients may contribute to decreased long-term valve deterioration.
• The Trifecta valve may offer improved durability in PVR for congenital heart disease.