Hemodynamic performance and incidence of patient–prosthesis mismatch of small-sized Trifecta pericardial aortic valves

Objectives Small-sized bioprosthetic valves are sometimes associated with suboptimal hemodynamic performance, leading to a patient–prosthesis mismatch. Trifecta pericardial valves are designed to improve hemodynamic performance. The purpose of this study was to investigate the hemodynamic properties of small-sized Trifecta valves and their efficacy in preventing a patient–prosthesis mismatch. Methods This was a retrospective analysis of 108 patients undergoing surgical aortic valve replacement with a Trifecta valve of 23 mm or less in a single Japanese institution. The hemodynamic performance was evaluated with an echocardiography examination in all patients after surgery, and the development of a patient–prosthesis mismatch was judged with the measured in vivo indexed effective orifice area. Results There was one early and seven late mortalities. There were no valve explants due to structural valve deterioration. Postoperative mean pressure gradients of 19-, 21-, and 23-mm valves were 15.1, 11.4, and 9.0 mmHg, respectively. The effective orifice area of 19-, 21-, and 23-mm valves was 1.41, 1.69, and 1.78 cm 2 , respectively. Patient–prosthesis mismatch occurred in 14 patients (1 severe and 13 moderate) and the incidence was 13.0% (15.4% in 19 mm, 18.0% in 21 mm, and 3.3% in 23 mm). Conclusions The small-sized Trifecta valves showed excellent hemodynamic performance and were associated with a low incidence rate of patient–prosthesis mismatch.