Hemodynamic Performance during Exercise of the New St. Jude Trifecta Aortic Bioprosthesis: Results from a French Multicenter Study

Background: Initial experience with the new St. Jude Trifecta pericardial aortic stented bioprosthesis shows an excellent resting hemodynamic profile. Little is known about changes in the hemodynamic profile of the Trifecta valve during exercise. Methods: Between February 2011 and November 2012, 85 patients (49 men; mean age, 76 +/- 7 years) with severe symptomatic aortic stenosis who underwent aortic valve replacement with the Trifecta bioprosthesis at three centers in France (Amiens, Rennes, and Angers) underwent quantitative Doppler echocardiographic at rest, during low-level exercise (25 W), and during peak exercise (68 +/- 21 W), 6 months after aortic valve replacement. Results: Mean peak transvalvular aortic velocity, mean transvalvular gradient, and mean left ventricular ejection fraction for all valve sizes were 211 +/- 35 cm/sec, 10 +/- 3 mm Hg, and 62 +/- 10% at rest; 237 +/- 48 cm/sec, 13 +/- 4 mm Hg, and 64 +/- 10% during low-level exercise; and 248 +/- 70 cm/sec, 15 +/- 5 mm Hg, and 67 +/- 10% during peak exercise, respectively. Mean effective orifice area was 1.84 +/- 0.42 cm(2) at rest, 1.86 +/- 0.84 cm(2) (P = .92) during low-level exercise, and 1.95 +/- 0.62 cm(2) (P = .49) during peak exercise. The prevalence of prosthesis-patient mismatch was low in the overall series (23%) and increased to 30% for the smallest valve sizes (19 and 21 mm). Conclusions: The new Trifecta bioprosthesis provides an excellent hemodynamic profile both at rest and during exercise. This type of valve could be an appropriate choice in patients with small aortic annular diameters, to avoid prosthesis-patient mismatch.