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You are here: Contents > 2018 > Volume 27 Number 2 March 2018 > AORTIC VALVE DISEASE > A Propensity Matched Analysis of Outcomes and Age- and Gender-Matched Population Survival Benefit Between Trifecta™ versus all Bioprosthetic Isolated Aortic Valve Replacements

A Propensity Matched Analysis of Outcomes and Age- and Gender-Matched Population Survival Benefit Between Trifecta™ versus all Bioprosthetic Isolated Aortic Valve Replacements

Mohamad Bashir1,4, Amer Harky1,2, Benjamin Adams1, Matthew Shaw3, Giridhara Goli1, Shirish Ambekar1, John Yap1, Kulvinder Lall1

1Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
2Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff, UK
3Department of Research & Innovation, Liverpool Heart & Chest Hospital, Liverpool, UK
4Electronic correspondence: drmbashir@mail.com

Background and aim of the study: The need for compatible biological prostheses in a rapidly aging population of cardiac patients with aortic valve disease requiring aortic valve replacement (AVR) is pushing biotechnologies towards a quest for the ideal prosthetic valve. The study aim was to comparatively evaluate the cumulative quality outcomes between all isolated bioprosthetic AVRs and the present population cohort, which underwent isolated AVR using a Trifecta™ stented valve.

Methods: A retrospective review was undertaken of a single institution at which details of isolated aortic valve surgery activity were prospectively recorded between October 2010 and June 2017. Biological valve implantations were identified and categorized as Trifecta valves or other. Propensity score matching was used to achieve equivalence between preoperative patient demographics and comorbidities. Groupwise comparisons were made of in-hospital outcomes and follow up survival.

Results: A total of 141 isolated Trifecta AVR implants and 879 other biological aortic valve procedures was identified during the study period. After 6:1 propensity score matching, there were 127 patients in the Trifecta group

and 762 in the comparison group, with no statistically significant differences in their preoperative or operative characteristics. There were no significant differences between groups with respect to in-hospital mortality (0.8% Trifecta versus 2.0% other; p = 0.71), stroke (3.2% Trifecta versus 1.1% other; p = 0.08), reoperation (6.3% Trifecta versus 4.6% other; p = 0.41), postoperative dialysis (0% Trifecta versus 2.1% other; p = 0.15) or postoperative length of stay (both medians 6 days; p = 0.20). Groupwise survival data were also analyzed, including matching the study cohort by age and gender to the general population, using ONS life tables. The log-rank p-value comparing Trifecta with other biological valves was 0.77. Visual inspection of the confidence intervals showed no difference between the study patients and the age- and gender-matched general population.

Conclusion: Although Trifecta and all bioprosthetic valves used for AVR among the patient cohort were associated with low morbidity and mortality, the five-year survival in the matched cohort amongst Trifecta and all bioprosthetic valves, along with the age- and gender-matched survival of the United Kingdom general population, showed no significant deviation.

The Journal of Heart Valve Disease 2018;27:141-146


A Propensity Matched Analysis of Outcomes and Age- and Gender-Matched Population Survival Benefit Between Trifecta™ versus all Bioprosthetic Isolated Aortic Valve Replacements

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