Comparison of Implantability, Early Post-Operative Valve Function and Structural Valve Deterioration between the Carpentier-Edward Perimount Magna Valve and St. Jude Medical Trifecta Valve

Atsushi Aoki＊	Tadashi Omoto＊	Kazuto Maruta＊
Tomoaki Masuda＊	Yui Horikawa＊

（Department of Surgery, Division of Cardiovascular Surgery, Showa University School of Medicine＊, Tokyo, Japan）

Purpose:Easy and safe implantability, good post-operative valve function and good long-term durability are required for any bioprosthetic valve implanted in aortic position. The Carpentier Edwards Perimount Magna valve（Magna）was introduced in 2009 and the St. Jude Medical Trifecta valve（Trifecta）was introduced in 2012 to our institution. In this study, we compared implantability, early post-operative valve function and structural valve deterioration（SVD）between these two valves. Patients and Methods:Between January 2009 and December 2019, Magna or Trifecta were electively implanted for 254 patients（Magna 151 patients and Trifecta 103 patients）and these patients were included in this study. Implantability was evaluated by occurrence of intraoperative valve dysfunction. Early post-operative valve function was evaluated by mean pressure gradient（m-PG）and indexed aortic valve area（AVAI）by ultrasonography performed 10 days after surgery. The relationship between indexed bioprosthetic valve orifice area calculated from internal diameter（GOAI）and AVAI was evaluated. If there was a significant relationship between GOAI and AVAI, maximum body surface area（BSA）to obtain AVAI●0.85cm2/m2 was estimated from 99% reliable interval of regression line. Results:Age, gender, and BSA did not differ between the two groups. There was no intraoperative valve dysfunction in Magna;however we experienced one patient with severe aortic regurgitation due to stent distortion by the aortic wall during surgery with the 25 mm Trifecta valve. For this patient, Trifecta was replaced with Magna intra-operatively. In the 19mm valve, AVAI was significantly larger（1.12±0.27cm2/m2 vs. 0.88±0.21cm2/m2, p＜0.001）and m-PG was significantly lower（8.7±2.7mmHg vs. 17.2±6.3mmHg, p＜0.001）in Trifecta. The frequency of AVAI＜0.85cm2/m2（24% vs. 49%, p＝0.036）and the frequency of m-PG●20mmHg（0% vs. 26%, p＝0.006）were significantly less in Trifecta. There was significant relationship between GOAI and AVAI in both valves. Maximum BSA to obtain AVAI ●0.85cm2/m2 was estimated as 1.35m2 in Magna and 1.50m2 in Trifecta. In the 21mm valve, AVAI was significantly larger（1.14±0.23cm2/m2 vs. 0.92±0.22cm2/m2, p＜0.001）and m-PG was significantly lower（7.8±3.2mmHg vs. 14.6±4.7mmHg, p＜0.001）in Trifecta. The frequency of AVAI＜0.85cm2/m2 was significantly less in Trifecta（11% vs. 42%, p＝0.002）;however, the frequency of m-PG●20mmHg did not differ significantly. There was a significant relationship between GOAI and AVAI in Magna and Trifecta. Maximum BSA to obtain AVAI ●0.85cm2/m2 was estimated as 1.49m2 in Magna and 1.70m2 in Trifecta. In the 23 and 25mm valves, AVAI was significantly larger and m-PG was significantly lower in Trifecta. However neither the frequency of AVAI＜0.85cm2/m2 nor m-PG●20mmHg differed between the two valves. There was one early（27 months after surgery）SVD due to leaflet tear in Trifecta and two SVDs due to leaflet calcification more than 10 years after surgery in Magna. Conclusion:For Trifecta implantation, valve size selection seemed to be important and larger valves should be avoided with narrow ST junctions. Selection of 19 and 21mm Magna valves should be limited for the patient with a BSA less than 1.35 and 1.49m2 respectively. In Trifecta, early SVD might occur and careful follow-up is necessary.

 

Jpn. J. Cardiovasc. Surg. 49:243-252（2020）

Keywords：Carpentier-Edwards Perimount Magna valve;St. Jude Medical Trifecta valve;implantability;valve function;structural valve deterioration