Early Hemodynamic Performance of the Epic™ Max Triple Composite Porcine Aortic Valve: A Benchmark for Future Valve-in-Valve Interventions

Abstract

Lifetime management of aortic stenosis has become a major focus of ongoing research. As valve-in-valve (ViV) procedures gain more relevance, pre-emptive surgical valve selection plays a key component of long-term planning. We report our early hemodynamic experience with the porcine Epic Max valve, which was engineered to improve compatibility with future ViV procedures. Between August 2024 and May 2025, a total of 50 Epic Max valves were implanted at our center. Baseline characteristics, operative details, and postoperative hemodynamic data were measured postoperatively and at a second early (median 32 days) follow-up. The median age was 72.7 years (IQR 70.7-75.3), and 92% were males. Procedures were performed via a trans-axillary approach in 52%, median sternotomy in 44%, and mini-sternotomy in 4% of cases. The median preoperative left ventricular ejection fraction was 60% (IQR 45-65). The overall mean pressure gradient (MPG) was 10.0 mm Hg (IQR 9.0-13.0) postoperatively, and 9.0 mm Hg (IQR 8.0-11.5) at 2nd follow-up. Corresponding peak gradients were 19 mm Hg (IQR 17.0-29.0) postoperatively and 17.7 mm Hg (IQR 15.0-23.9) at 2nd follow-up. For 23 mm valves (n = 30), MPG was 10.0 mm Hg (IQR 9.0-12.8), and 9.0 mm Hg (IQR 8.0-11.0) at 2nd follow-up. For 25 mm valves (n = 17), MPG was 11.0 mm Hg (IQR 8.5-14.0), and 8.0 mm Hg (IQR 7.0-10.0) at 2nd follow-up. The Epic Max valve showed excellent early hemodynamic performance with low postoperative gradients (<10 mm Hg). Its design supports future ViV procedures, though ViV outcomes remain to be determined.