Thorac Cardiovasc Surg 2013; 61 - SC129
DOI: 10.1055/s-0032-1332627

Hemodynamic performance of a new aortic valve bioprostheses (Trifecta; St. Jude Medical) at rest and exercise. A comparative study

T Hanke 1, EI Charitos 1, U Stierle 1, C Auer 1, HH Sievers 1
  • 1UK-SH Campus Lübeck, Klinik für Herzchirurgie, Lübeck, Germany

Objectives: Since blood flow impairment by aortic valve prosthesis is characteristically dynamic, this dynamic component is best and thoroughly appreciated by exercise Doppler echocardiography. We sought to determine hemodynamics of a new pericardial aortic bioprostheses (Trifecta™, St. Jude Medical, T-AVB) at rest, during exercise and a 10 min recovery period in comparison to assumingly superior aortic valve replacement strategies, e.g. the pulmonary autograft (Ross Operation, RO), stentless aortic valve replacement with a Medtronic Freestyle prosthesis (MF-AVB) and a healthy control group.

Methods: Hemodynamics at rest, during supine exercise stress testing and a 10 min recovery period were continuously evaluated in 32 patients (mean age 70.8 ± 6.7 y) with T-AVR (mean follow-up 5 ± 2 m, mean valve size 23 ± 2), 49 patients with RO (mean age 43.5 ± 13.7 y), in 39 patients with a MF-AVB (mean age 64.6 ± 9.4 y, mean valve size 25 ± 2) and in 26 healthy patients (mean age 39 ± 9 y). Measurements included mean outflow tract gradient (δpmean, mmHg), effective orifice area index (EOAI, cm2/m2) and valvular resistance (vR, dyn* s* cm-5).

Results: Mean BSA for the T-AVB was 1.93 ± 0.24m2, median 1.97m2. δpmean at rest was 7.2 ± 3.35 mmHg, EOAI 0.84 ± 0.22 cm/m2, vR 50.7 ± 23.2 dynesxsecxcm-5. Supine stress testing with stepwise 25 W increase of workload up to a maximum of 100 W induced an increase of T-AVB EOAI to 0.98 ± 0.27 cm/m2, vR to 62.6 ± 25.3 dynesxsecxcm-5, δpmean to 10.2 ± 4.6 mmHg, respectively (p < 0.001 for all comparisons). During the post exercise recovery period, δpmean, EOAI, and vR showed a prompt normalization within 5 minutes after cessation of stress testing.

At all 3 measurement points, patients with a T-AVR revealed higher gradients, a smaller EOAI and higher valvular resistance when compared to the RO and a healthy control group. Compared to MF-AVB, T-AVB showed superior performance throughout series of measurements with lower gradients, a significantly larger EOAI and lower vR.

Conclusions: When comparing 3 different types of aortic valve replacement procedures to a healthy population, patients with a stented T-AVR procedure revealed promising hemodynamics during exercise with a nearly physiological recovery pattern during post exercise recovery. This might translate into better clinical outcome and longer durability.