Dell'Aquila Angelo M, Schlarb Dominik, Schneider Stefan R B, Sindermann Jürgen R, Hoffmeier Andreas, Kaleschke Gerrit, Martens Sven, Rukosujew Andreas
Department of Cardiac Surgery, Universitätsklinikum Münster, Münster, Germany.
Interact Cardiovasc Thorac Surg. 2013 Feb;16(2):112-5. doi: 10.1093/icvts/ivs460. Epub 2012 Nov 15.
The Trifecta valve (St. Jude Medical) was introduced into clinical practice as a tri-leaflet stented pericardial valve designed for supra-annular placement in the aortic position. The present study aims to evaluate the preliminary results with this new bioprosthesis.
Seventy patients underwent aortic valve replacement (AVR) with the Trifecta valve between August 2010 and December 2011. Thirty-three patients were male and 37 were female (52.9%). Mean age was 74.65 ± 7.63 (range 47-90 years). Prevalent cause of AVR was aortic stenosis in 64 (91.43%) patients. The mean preoperative pressure gradient was 50 ± 17 (range 20-84 mmHg), and the mean aortic valve area was 0.77 ± 0.33. Five (7.14%) patients were operated on due to aortic valve endocarditis. One patient was operated on due to isolated, severe aortic insufficiency. All patients were in New York Heart Association functional class III or IV. Twenty-eight (40%) patients underwent concomitant procedures.
Concomitant procedures were coronary artery bypass grafting (n = 25), mitral valve replacement (n = 1), ablation of atrial fibrillation (n = 1) and septal myomectomy (n = 1). There were no intraoperative deaths. The 30-day in-hospital mortality was 2.85% (2 of 70). One late death occurred during the in-hospital stay due to a multiorgan failure on postoperative day 60. There were 2 (2.85%) perioperative strokes. Mean pressure gradient decreased significantly from a preoperative value of 50 ± 17 mmHg to an intraoperative gradient of 9 ± 4 mmHg (Table 3). The mean gradients were 14, 11, 11, 8 and 6 mmHg for the 19, 21, 23, 25 and 27 mm valve size, respectively. No prosthesis dislocation, endocarditis, valve thrombosis or relevant aortic regurgitation was observed at discharge.
The initial experience with the Trifecta valve bioprosthesis shows excellent outcomes with favourable early haemodynamics. Further studies with longer follow-up are needed to confirm those preliminary results.
Trifecta瓣膜（圣犹达医疗公司）作为一种三叶瓣带支架心包瓣膜被引入临床实践，设计用于主动脉位置的瓣环上放置。本研究旨在评估这种新型生物假体的初步结果。
2010年8月至2011年12月期间，70例患者接受了Trifecta瓣膜主动脉瓣置换术（AVR）。男性33例，女性37例（52.9%）。平均年龄为74.65±7.63岁（范围47 - 90岁）。AVR的主要病因是64例（91.43%）患者的主动脉瓣狭窄。术前平均压力阶差为50±17（范围20 - 84 mmHg），平均主动脉瓣面积为0.77±0.33。5例（7.14%）患者因主动脉瓣心内膜炎接受手术。1例患者因单纯严重主动脉瓣关闭不全接受手术。所有患者均处于纽约心脏协会功能分级III级或IV级。28例（40%）患者接受了同期手术。
同期手术包括冠状动脉旁路移植术（n = 25）、二尖瓣置换术（n = 1）、房颤消融术（n = 1）和室间隔心肌切除术（n = 1）。无术中死亡。30天住院死亡率为2.85%（70例中的2例）。1例晚期死亡发生在住院期间，术后第60天因多器官功能衰竭。有2例（2.85%）围手术期卒中。平均压力阶差从术前的50±17 mmHg显著降至术中的9±4 mmHg（表3）。19、21、23、25和27 mm瓣膜尺寸的平均压力阶差分别为14、11、11、8和6 mmHg。出院时未观察到假体脱位、心内膜炎、瓣膜血栓形成或相关主动脉瓣反流。
Trifecta瓣膜生物假体的初步经验显示出良好的结果和有利的早期血流动力学。需要进一步进行更长时间随访的研究来证实这些初步结果。
