Perceval or Trifecta to Prevent Patient-Prosthesis Mismatch

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Prosthetic Devices

Background:

• Patient-prosthesis mismatch (PPM) is a complication following aortic valve replacement (AVR).
• The Trifecta and Perceval prostheses are advanced aortic valves with distinct hemodynamic profiles.
• Reducing PPM is crucial for long-term patient outcomes after AVR.

Purpose of the Study:

• To compare the prevalence of moderate and severe PPM between Trifecta and Perceval aortic valve prostheses.
• To evaluate the impact of prosthesis choice on PPM incidence in patients undergoing AVR.
• To determine which prosthesis offers superior hemodynamic performance regarding PPM.

Main Methods:

• Retrospective analysis of 516 patients undergoing AVR with Trifecta or Perceval prostheses (2016-2020).
• Calculation of PPM prevalence stratified by prosthesis type and size.
• Multinomial logistic regression analysis to assess the association between prosthesis type and PPM risk.

Main Results:

• Moderate PPM occurred in 8.6% of Trifecta recipients versus 21.4% of Perceval recipients (p < 0.001).
• Severe PPM was observed in 2.1% with Trifecta and 3.8% with Perceval (p = 0.33).
• Trifecta prosthesis was associated with a 50% reduction in moderate PPM risk (OR = 0.5; p = 0.02) compared to Perceval.

Conclusions:

• Both Trifecta and Perceval prostheses demonstrate a low risk of severe PPM.
• The Trifecta prosthesis significantly reduces the incidence of moderate PPM compared to the Perceval prosthesis.
• Prosthesis selection plays a role in mitigating moderate PPM after aortic valve replacement.