Mechanisms of Trifecta Valve Failure and Contemporary Approaches to Reintervention: Perceval vs Valve-in-Valve Transcatheter Aortic Valve Implantation

We recommend that patients following Trifecta implantation with preoperative impaired kidneys, postoperative low effective orifice area (EOA) indexes, and prosthesis-patient mismatch be closely followed with echocardiograms to detect a possible Trifecta failure. Replacing a failed Trifecta valve with a sutureless Perceval could be an excellent option to approach a pre-existing small native annulus. Valve-in-valve transcatheter aortic valve implantation is a less favourable option due to the risk of a reduced EOA, though it may still be considered in selected patients with larger annuli.