(VP038) EARLIER STRUCTURAL VALVE DETERIORATION AND TIME TO REOPERATION IN AN EXTERNALLY WRAPPED VALVE

Background: The purpose of the study was to compare the durability of two aortic prostheses (Edwards Perimount valve and the externally wrapped St Jude Medical Trifecta valve) as a function of time to structural valve deterioration (SVD) and time to reoperation. Previous studies have reported increased SVD with externally wrapped valves. Here we describe the time function of fallibility.

METHODS AND RESULTS: 757 consecutive patients implanted with a bioprosthetic heart valve in the aortic position for non-endocarditis indications were examined. Patients were grouped into the Trifecta group (383 [51.9%]) or the Edwards group (364 [48.1%]). SVD was defined as a decrease of ≥ 0.6 cm2 for aortic valve area, or a ≥ 20 mmHg increase in gradient, or ≥ moderate aortic insufficiency, or ≥ moderate stenosis, or repeat surgical or transcatheter aortic valve replacement. A time-to-event analysis was performed.

Patients in the Trifecta group more often had hyperlipidemia (85.2% vs 61.7%; P < 0.0001), coronary artery disease (53.5% vs 44.7%; P =0.02), and atrial fibrillation (38.5% vs 23.4%; P < 0.0001). SVD occurred in 147 patients (Trifecta, n=83; Edwards, n=64) within 9.3 years. Kaplan-Meier time-to-event analysis shows earlier onset of SVD in the Trifecta group (P=0.0032). Also seen was an earlier occurrence of reoperation (SAVR or TAVR) in the Trifecta group (P < 0.0001). By 4-years post-implantation an earlier onset of SVD, and occurrence of reoperation was evident becoming more pronounced over time.

Conclusion: Occurrence of SVD with the externally wrapped Trifecta aortic bioprothesis is higher than that in the Edwards aortic bioprosthetic valves. This becomes apparent by 4- years post-implantation and thereafter the difference accelerates.