Early Structural Valve Degeneration of Trifecta Bioprosthesis

Abstract Background Structural valve deterioration (SVD) is a major flaw of bioprostheses. We recently observed an apparent increase in the SVD rate among those received the Trifecta bioprosthesis. Methods We retrospectively reviewed 1,058 consecutive patients who underwent aortic valve placement with a stented bioprosthesis between January 2011 and December 2015. Patients were grouped into Trifecta (508 [48.0%] with Trifecta) and non-Trifecta Group (550 [52.0%] with others). Results Patients in Trifecta Group were older (69.7 vs. 64.6, p=0.001), were more likely female (40.4 vs. 28.0%, p=0.001), more often had aortic stenosis (85.1 vs. 77.1%, p=0.001) and received smaller size valve (23.0 vs. 25.0 mm, P 50% of Trifecta Group, whereas none in non-Trifecta Group. The cumulative incidence of SVD was higher in Trifecta Group both in the entire (13.3 vs. 4.6%, p=0.010) and the younger (age ≤ 65) cohort (27.9 vs. 6.9%, p=0.004) with notable increase between 5 and 7 years. Multivariable competing risks regression in Trifecta Group revealed younger age (hazard ratio: 0.56 per 10-point decrease, 95% confidence interval: 0.44-0.72, p Conclusions The SVD rate of the Trifecta has been greater than expected, compared with other bioprosthesis, particularly in younger patients. In view of the large number of Trifecta implanted worldwide, further investigation involving other institutions is warranted.