CONGRESS ABSTRACT

Aim: To compare follow-up results of the aortic valve replacement with the implantation of Perceval sutureless bioprosthesis and St. Jude Trifecta sutured bioprosthesis (the single-center Perfecta Study), specifically evaluating the following end-points: survival, event-free survival rates, and the impact of the structural valve deterioration (SVD) on the freedom from reintervention. Methods: Between December 2014 and June 2023, 280 patients underwent aortic valve replacement with Trifecta implantation (n=220, mean age 75.2±6.5 years) and Perceval implantation, when indicated (n=60, mean age 77.9±5.1 years). Two-hundred and seventy-four survivors (Trifecta=214, Perceval=60) were evaluated during the follow-up. Results: At 7 years for both types of prosthesis, Trifecta vs Perceval, survival (68%±4.1% vs 89%±4.8%, P =0.19), freedom from cardiac death (90±2.3% vs 94±1.7%, P =0.38), from endocarditis (96%±1.4% vs 94%±3.0%, P =0.99) and from reintervention (98%±1.4% vs 100%, P =0.13) were similar. Chronic pulmonary disease (HR: 2.3), advanced age (HR: 1.2), three-vessel coronary disease-left main stem disease (HR: 2.9) were independent predictors of reduced survival and freedom from cardiac death. Overall SVD was observed in 60 Trifecta implants, of which its initial stages in 53 cases, and in one Perceval implant. Freedom from overall SVD was 74%±4.2% vs 93%±6.4% ( P =0.09). Moderate patient-prosthesis mismatch (PPM) was more frequently observed in the Trifecta vs Perceval group (n=38 [17.3%] vs n=5 [8.2%], P =0.004). Independent predictors of SVD, both in the initial stages and overall, were Trifecta implantation (HRs: 20.5, 22.4) and moderate PPM (HRs: 2.5, 2.3). NYHA functional class was significantly improved compared to preoperative in both groups (P<0.001). Conclusions: Both bioprostheses appear to confer equally satisfactory late outcomes. Although Trifecta prosthesis carries a higher risk of SVD, starting from the medium-term follow-up, this risk does not seem to be significantly associated with worse clinical conditions and need for redo operation, at least during a medium-long term period. Close clinical and outpatient echocardiographic patients’ monitoring may allow to prevent the progression of SVD over time, thus reducing risk of reoperation. Perceval prosthesis can be considered a reasonable option in the context of the latest generation biological prostheses.