Surgical aortic valve replacement by St. Jude/Abbott -Trifecta® bioprostheses: Durability and long-term outcomes

Aim: The STJ/Abbott-Trifecta® bioprosthesis, known for its low post-implantation gradients in small aortic annuli, was withdrawn from the market in July 2023 due to early structural valve deterioration (SVD). This study evaluates its mid- to long-term outcomes and durability (up to 10 years) in patients treated at our institution. Material and Methods: From 2010 to 2018, 164 adult patients (≥18 years) underwent aortic valve replacement with STJ/Abbott-Trifecta® bioprostheses at the University Hospitals of Geneva (HUG). We retrospectively analyzed 72 patients with complete follow-up data from hospital records and referring cardiologists. Results: The study cohort had a mean age of 77±10.6 years (62.5% male). At follow-up, only 34 patients (47.2%) were alive. Isolated AVR was performed in 30 patients (41.7%), while 42 (58.3%) underwent concomitant procedures. The most common valve sizes were 21 mm (31.9%) and 23 mm (31.9%). Despite a high proportion of small valves (≤21 mm, 37.5%), only 2 patients (2.4%) had severe patient-prosthesis mismatch. Hospital mortality was 13% (11/83 patients). Significant hemodynamic deterioration due to SVD was observed 6-8 years post-implantation, requiring reoperation in 12 patients (16%) within 6.3±2.9 years. Kaplan-Meier estimates for 5-year survival varied by valve size: 19 mm (20%), 21 mm (56%), 23 mm (90%), 25 mm (77.9%), and 27 mm (75%). Conclusion: While STJ/Abbott-Trifecta® bioprostheses provided low gradients in small annuli, they showed high early degeneration rates, necessitating frequent reoperations. Given the 2023 market withdrawal, patients with these valves require close echocardiographic monitoring.