Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis.

Background: Aortic prosthesis area (EOA) is computed by continuity equation from left ventricular (LV) stroke volume (SV) derived from LV outflow tract diameter (LVOT ) or, when unmeasurable, from LV volumes (SV ). There is evidence to suggest LVOT ellipticity and recommend 3D LVOT area (LVOT ) adoption in aortic stenosis. We sought to evaluate if the same concept applies to supra-annular aortic prosthesis comparing SV and EOA derived from LVOT (EOA ) and from LVOT (EOA ). EOA computed from SV (EAO ) accuracy was evaluated in this setting. Patient-prosthesis mismatch (PPM) was compared among different EOA computations.

Methods: A consecutive series of 202 patients (aged 81 ± 4 years, 43% males) underwent St.Jude Trifecta aortic valve replacement (AVR) and were followed up with echocardiography at one-year (335 ± 31 days). All measurements followed the EACVI or ASE guidelines, 3D X-plane modality was used to compute SVv and measure LVOT ; SV was calculated from LVOT (SV ) and LVOT (SV ). PPM was indexed EOA <0.65 cm²/m².

Results: LVOT showed a significant ellipticity index (1.17 ± .27), independent of prosthesis size. EOA (1.70 ± 0.55 cm²) was less than EOA (1.95 ± 0.62 cm²) (P < .0001). SV was significantly lower than SV and SV . Bland-Altman analysis showed a significant correlation between SV and SV or SV although with large bias and imprecision. The correlations improved reducing bias and imprecision when LVOT time-velocity integral was <20 cm. PPM incidence was higher in EOA (15.6%) compared to EOA (P = .04) or EOA (P < .001).

Conclusions: In supra-annular AVR, LVOT retains its elliptical shape and LVOT yielded larger prosthesis EOA with lower PPM incidence. PPM may be overestimated by EOA .