Trifecta Aortic Bioprosthesis: Midterm Results in 1,953 Patients From a Single Center

The St. Jude Medical Trifecta bioprosthesis (St. Jude Medical, St. Paul, MN) is a bovine pericardial valve mounted on a titanium stent. The objective of this study was to report a single-center experience with the Trifecta aortic valve.

Patients undergoing aortic valve replacement (AVR) with the Trifecta valve between 2011 and 2017 at a single center were included. The primary outcome was overall survival. Secondary outcomes included operative mortality and morbidity, aortic valve reoperations, and reoperation for structural valve deterioration. Echocardiographic outcomes were evaluated. Multivariable logistic regression models were created to identify predictors of death.

The study included 1,953 Trifecta valve implants. Operations included isolated AVR (45% [n = 869]), AVR plus coronary artery bypass grafting (40% [n = 771]), and AVR plus mitral valve operation (13% [n = 254]). Overall survival at 30 days, 1 year, and 5 years was 94.9%, 89.7%, and 69.8%, respectively. Overall freedom from aortic valve reintervention was 96.4% at 5 years, with an overall freedom from reoperation for structural valve deterioration of 98.7% at 5 years. For elective isolated AVRs, survival was 98.6%, 94.1%, and 77.5% at 30 days, 1 year, and 5 years, respectively. The 5-year freedom from aortic valve reintervention and reoperation for structural valve deterioration for elective isolated AVRs was 97.6% and 99.1%, respectively. Overall mean gradients were 6.8 ± 5.3 mm Hg postoperatively and remained low at 10.1 ± 6.2 mm Hg at 1 year.

This is the largest series reporting on outcomes of the Trifecta valve. Our results demonstrate that this valve can be safely implanted in the aortic position with excellent midterm durability and hemodynamics.