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Mid-Term Follow-Up of Haemodynamic Performance of the St. Jude Medical Trifecta Aortic Bioprosthesis - The Training Perspective
Amir Sepehripour, Jacob Chacko, Kulvinder Lall.
St Bartholomew's Hospital, London, United Kingdom.

OBJECTIVE: The Trifecta aortic bioprosthesis provides exceptional haemodynamic performance, durability and implantability. The unique design, encompassing a contoured silicone insert within a unique cuff is specifically designed to conform to the native annulus shape for proper seating and minimal risk of paravalvular leak. The aim of this prospective study was to evaluate haemodynamic performance of valves implanted by cardiothoracic trainees at a single UK centre.
METHODS: Twenty-one consecutive patients undergoing aortic valve replacement using the Trifecta valve performed by trainees at a single UK centre over a 36-month period were included. Patients undergoing concomitant cardiac procedures were included. Assessment of haemodynamic function was carried out using transthoracic echocardiography pre-operatively and at follow-up, as well as transoesophageal echocardiography intra-operatively.
RESULTS: The study population consisted of 21 patients (14 male, 7 female). Mean age was 72.4±7.6 years. Implanted valve sizes were 19mm (n=1), 21mm (n=7), 23mm (n=9), 25mm (n=3) and 29mm (n=1). Overall mean post-operative pressure gradients were 6.47±1.7 mmHg (mean) and 13.42±5.3 mmHg (peak). Subgroup mean post-operative pressure gradients were 7.21±3.1mmHg, 7.51±3.1mmHg, 7.63±2.4mmHg, 7.31±4.6mmHg, 7.46±4.9mmHg, for the 19, 21, 23, 25 and 27mm cohort respectively. Overall mean post-operative left ventricular ejection fraction was 56±0.12%. Overall mean effective orifice area was 1.63±0.7cm2. All valves were well-seated and only 2 exhibited trivial regurgitation.
CONCLUSIONS: Our experience demonstrates the excellent haemodynamic performance of the Trifecta bioprosthesis in implantations performed by surgical trainees, resulting from the innate superior haemodynamic properties of the Trifecta valve as well as the simple yet faultless implantability of the valve.

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