Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Interact Cardiovasc Thorac Surg. 2021 Jan 1;32(1):39-46. doi: 10.1093/icvts/ivaa236.
Despite promising short- and mid-term results for durability of the Trifecta valve, contradictory reports of early structural valve deterioration (SVD) do exist. We investigated the incidence of SVD after surgical aortic valve replacement (SAVR) with the Trifecta in our single-centre experience.
Data of 347 consecutive patients (mean age 71.6 ± 9.5 years, 63.4% male) undergoing SAVR with the Trifecta between 2011 and 2017 were analysed. Clinical and echocardiographic reports were obtained with a median follow-up of 41 months (1114 patient years).
Isolated SAVR was performed in 122 patients (35.2%), whereas 225 patients (64.8%) underwent concomitant procedures. The median EuroSCORE II was 4.0 (0.9; 7.1) and 30-day mortality was 3.7% (n = 13). Kaplan-Meier estimates for the freedom of overall mortality at 1, 5 and 7 years were 88.7 ± 1.7%, 73.7 ± 2.6% and 64.7 ± 4.2%, respectively. SVD was observed in 25 patients (7.2%) with a median time to first diagnosis of 73 months. Freedom of SVD was 92.5 ± 0.9% at 5 years and 65.5 ± 7.1% at 7 years. Thirteen patients underwent reintervention for SVD (6 re-SAVR, 7 valve-in-valve), resulting in a freedom of reintervention for the SVD of 98.5 ± 1.1% at 5 years and 76.9 ± 6.9% at 7 years.
We herein report one of the highest rates of SVD after SAVR with the Trifecta. These data indicate that the durability of the prosthesis decreases at intermediate to long-term follow-up, leading to considerable rates of reintervention due to SVD.
尽管 Trifecta 瓣膜在短期和中期的耐用性方面表现出色，但确实存在早期结构性瓣膜退化（SVD）的相互矛盾的报告。我们在单中心经验中调查了使用 Trifecta 进行主动脉瓣置换术（SAVR）后的 SVD 发生率。
分析了 2011 年至 2017 年间使用 Trifecta 接受 SAVR 的 347 例连续患者（平均年龄 71.6±9.5 岁，63.4%为男性）的数据。获得了临床和超声心动图报告，中位随访时间为 41 个月（1114 患者年）。
122 例（35.2%）患者仅行 SAVR，225 例（64.8%）患者同时行其他手术。中位 EuroSCORE II 为 4.0（0.9；7.1），30 天死亡率为 3.7%（n=13）。Kaplan-Meier 估计的 1、5 和 7 年总死亡率的无事件生存率分别为 88.7±1.7%、73.7±2.6%和 64.7±4.2%。25 例（7.2%）患者出现 SVD，首次诊断的中位时间为 73 个月。5 年时 SVD 的无事件生存率为 92.5±0.9%，7 年时为 65.5±7.1%。13 例患者因 SVD 接受再介入治疗（6 例再 SAVR，7 例瓣膜内植入），5 年和 7 年时 SVD 再介入治疗的无事件生存率分别为 98.5±1.1%和 76.9±6.9%。
我们在此报告了使用 Trifecta 进行 SAVR 后 SVD 发生率最高的病例之一。这些数据表明，假体的耐用性在中期至长期随访中下降，导致因 SVD 而进行大量再介入治疗。
