Early midterm results after valve replacement with contemporary pericardial prostheses for severe AS

Abstract Background Clinical studies have demonstrated improved gradients after AVR with the Trifecta (TR) as compared to the Magna Ease (ME). Clinical benefits of this strategy have not been demonstrated. Methods Patients undergoing AVR for severe AS with either valve were included. Patients were excluded if they underwent concomitant procedures other than CABG. Inverse proportion treatment weighting was used in the analysis. The primary outcome was a composite of cardiac mortality, need for re-intervention, freedom from first CHF. Secondary outcomes included a) all-cause mortality b) the composite components and c) cumulative CHF admission. Follow-up echocardiograms were assessed in a cohort of patients to assess structural valve degeneration (SVD). Results There were 331 patients in the TR group and 360 patients in the ME group. The TR group had more females (48% vs 32%, p 0.05). There was no difference in all-cause mortality (HR 0.82 95% CI(0.42, 1.59), p=0.56) and five-year survival was 91.9% in ME and 93.4% in the TR group. There was no difference in cardiac death, re-intervention or first onset of CHF or incidence of SVD. There was no difference in the rate of admissions for CHF per 100 patients between the two valve types (p=0.19). Conclusions Early hemodynamic benefits have not translated into differences in medium-term clinical outcomes between these two valves and long-term follow-up is necessary.