[Early Structural Valve Deterioration of Third-generation Biological Prosthesis].

The third-generation Trifecta valve, Trifecta GT, has been used in Japan since 2012. The Trifecta GT is characterized by the external leaflet mounting, which increases the effective valve opening area and provide excellent hemodynamics. Lehmann et al. reported a good 8-year avoidance rate of 93.3% for structural valve deterioration( SVD) in 1,241 patients. There are three main causes of SVD after valve replacement using bioprostheses:pannus formation in the left ventricular outflow tract, calcification of the valve leaflets, and noncalcified leaflet tears. Goldman et al. reported 11 SVDs in 710 patients who underwent surgical implantation of Trifecta valve, 10 of which were due to calcification of the valve leaflets and only one of which was due to noncalcified leaflet tears. Herein, we report four cases of early SVD due to noncalcified leaflet tears after valve implantation using the Trifecta GT.