Association of the surgical technique with the structural valve deterioration of a bioprosthesis. A prospective cohort study

The Trifecta aortic valve is a prosthesis with externally mounted leaflets and a stent which may be deformed during implant. Our aim was to know if the use of the holder as a protection device during the knotting has an impact on the incidence of structural valve deterioration (SVD) or endocarditis. Prospective cohort study where all patients who underwent aortic valve replacement with a Trifecta aortic valve between 2013 and 2018 were included. The use of the holder as a protection device was collected in a database. Propensity-score matched methods were used and analyses were based on competing events. Death without SVD or prosthesis replacement not due to SVD were considered competing events. 782 patients were included, 352 pairs after the matching. Rates of SVD at 5 and 8 years were 5.8% (95% CI 3.5-8.7) and 13.6% (95% CI 9.2-18.9) in the group without holder and 2.3% (95% CI 1-4.5) and 7% (95% CI 4.2-10.8) in the group with holder; sHR=0.49 (95% CI 0.27 - 0.86; p=0.015). The risk of endocarditis at 8 years was 4.8% (95% CI 2.8 - 7.4) in the group without holder and 2.3% (95% CI 1.1 - 4.3) in the group with holder, sHR = 0.49 (95% CI 0.21-1.15, p=0.1). The use of holder as a protection device during the knotting of the Trifecta aortic valve is associated with less risk of SVD.