Suture technique does not affect hemodynamic performance of the small supra-annular Trifecta bioprosthesis

Objective: The study objective was to evaluate whether aortic valve replacement with the Trifecta valve (St Jude Medical Inc, St Paul, Minn) using simple sutures produces better hemodynamic performance than valve replacement with noneverting pledget-reinforced sutures.

Methods: We analyzed prospectively acquired 1-year hemodynamic data of patients with small aortic annulus sizes who were enrolled in a multicenter trial of the Trifecta aortic valve bioprosthesis and underwent aortic valve replacement with a 19-mm or 21-mm bioprosthesis between August 2007 and November 2009. We compared preoperative clinical information and 1-year postoperative hemodynamic data for noneverting pledget-reinforced sutures (group 1) versus everting mattress sutures or simple sutures (group 2).

Results: A total of 346 patients underwent aortic valve replacement: 269 in group 1 and 77 in group 2. Preoperative demographic characteristics for the 2 groups were similar. For groups 1 and 2, the mean gradient was 10.4 -4.7mmHg and 11.1-4.4mmHg for 19-mm valves, respectively, and 8.4-3.5mmHg and 8.8-3.6mmHg for 21-mm valves, respectively; the effective orifice area was 1.40 cm² and 1.25 cm² for 19-mm valves, respectively, and 1.57 cm² and 1.50 cm2 for 21-mm valves, respectively. The rate of severe prosthesis-patient mismatch (indexed effective orifice area -0.65 cm²/m²) was 18.6% (n = 11) and 25% (n = 6) for 19-mm valves, respectively, and 10.9% (n = 20) and 16.3% (n = 8) for 21-mm valves, respectively.

Conclusions: The suture method did not affect hemodynamic performance of supra-annular bioprostheses in patients with small aortic annulus sizes. Choice of suture technique should be determined by surgeon experience and local anatomic features.