Structural valve degeneration of bioprosthetic aortic valves: A network meta-analysis

Objective: To compare the rate of structural valve degeneration (SVD) following surgical aortic valve replacement associated with the Trifecta (TF) valve (St Jude Medical) versus other bioprosthetic valves.Methods: A systematic literature search was conducted for studies comparing durability of the TF prosthesis to other valve types, including Perimount (Edwards Lifesciences), Carpentier-Edwards Perimount Magna Ease (ME) (Edwards Lifescien-ces), and Mitroflow (LivaNova USA) after surgical aortic valve replacement. Random effect pairwise and network meta-analyses were performed to compare the inci-dent rate ratio of the composite primary outcome of SVD or reintervention due to SVD.Results: Ten studies with 31,029 patients were included, of whom 6832 received TF, 19,023 received Perimount, 3514 received ME, and 713 received Mitroflow. When compared with TF, ME was associated with lower rates of SVD or reintervention for SVD (incident rate ratio, 0.13; 95% CI, 0.02-0.92; P 1/4 .04). Similarly, at network meta-analysis, when compared with TF, only ME was associated with significantly lower rates of SVD or reintervention for SVD (incident rate ratio, 0.13; 95% CI, 0.02-0.97). ME (incident rate ratio, 0.18; 95% CI, 0.07-0.47) and PM (incident rate ratio, 0.34; 95% CI, 0.12-0.98) were associated with significantly lower rate of all-cause reintervention when compared with TF. No differences in the other sec-ondary outcomes were found.Conclusions: The TF valve is associated with significantly higher rates of SVD or reintervention for SVD than the ME valve, but not the Mitroflow valve. The TF valve was also associated with higher rates of all-cause reintervention than ME and Perimount valves. The underlying mechanism(s) of these findings warrant further investigation. (J Thorac Cardiovasc Surg 2023;166:52-9)

Automated summary

This study compared the rates of structural valve degeneration (SVD) following surgical aortic valve replacement with different bioprosthetic valves. The results showed that the ME valve had a lower SVD rate compared to the TF valve, but there was no significant difference between the TF valve and the Mitroflow valve. Additionally, the TF valve had higher rates of all-cause reintervention compared to the ME and Perimount valves.