Abstract

 

OBJECTIVES

The aim of this study was to evaluate the clinical and haemodynamic results after implantation of the Trifecta bioprosthesis.

METHODS

This study is a retrospective analysis of all patients undergoing Trifecta aortic valve replacement between 01 January 2012 and 31 December 2017 at the Ghent University Hospital. Univariable and multivariable analyses were performed to identify predictors of valve- and procedure-related complications and mortality. The haemodynamic performance was analysed by longitudinal Doppler echocardiography.

RESULTS

The mean age of the 182 patients was 77 [standard deviation (SD): 5.5] years; 54.9% were women. The mean follow-up was 39.8 (SD: 24.3) months. Overall survival at 1 and 5 years was 86% (SD: 3%) and 68% (SD: 4%), respectively, and overall freedom from structural valve deterioration was 100% and 98% at 1 and 5 years, respectively. There was no valve thrombosis nor early endocarditis. Urgent surgery was the only risk factor for early mortality in the multivariable analysis [P = 0.009, odds ratio 0.06, 95% confidence interval (CI) 0.01–0.5]. Preoperative atrial fibrillation was the most important predictor of late mortality (P = 0.001, hazard ratio 3.68, 95% CI 1.65–8.21). The average peak gradients were stable from discharge up to 1 and 5 years postoperatively [15 (SD: 6) and 17 (SD: 8) mmHg].

CONCLUSIONS

These results confirm the excellent clinical performance of the Trifecta valve, particularly in an elderly age group. Through the 7-year follow-up period, low transvalvular gradients persisted, and only a few patients needed reoperation. Although structural valve degeneration occurred rarely, it was unrelated to valve size or age at implantation; therefore, further long-term follow-up remains mandatory.

中文翻译：

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使用 Trifecta 生物瓣置换主动脉瓣后的中期临床和血流动力学结果

摘要

 

目标

本研究的目的是评估 Trifecta 生物假体植入后的临床和血流动力学结果。

方法

本研究是对 2012 年 1 月 1 日至 2017 年 12 月 31 日期间在根特大学医院接受 Trifecta 主动脉瓣置换术的所有患者的回顾性分析。进行单变量和多变量分析以确定瓣膜和手术相关并发症和死亡率的预测因子。通过纵向多普勒超声心动图分析血流动力学性能。

结果

182 名患者的平均年龄为 77 [标准差 (SD)：5.5] 岁；54.9% 是女性。平均随访时间为 39.8 (SD: 24.3) 个月。1 年和 5 年的总生存率分别为 86% (SD: 3%) 和 68% (SD: 4%)，1 年和 5 年的结构性瓣膜恶化的总体自由度分别为 100% 和 98%。没有瓣膜血栓形成和早期心内膜炎。在多变量分析中，紧急手术是早期死亡的唯一危险因素 [ P  = 0.009，优势比 0.06，95% 置信区间 (CI) 0.01-0.5]。术前房颤是晚期死亡率最重要的预测因素（P = 0.001，风险比 3.68，95% CI 1.65–8.21）。平均峰值梯度从出院到术后 1 年和 5 年是稳定的 [15 (SD: 6) 和 17 (SD: 8) mmHg]。

结论

这些结果证实了 Trifecta 瓣膜的出色临床性能，特别是在老年人群中。在 7 年的随访期间，低跨瓣压差持续存在，只有少数患者需要再次手术。虽然结构性瓣膜变性很少发生，但与瓣膜大小或植入年龄无关；因此，进一步的长期随访仍然是强制性的。