Clinical outcomes and hemodynamic performance of Dafodil™ aortic and mitral pericardial bioprosthesis: 1-year results from Dafodil-1 first-in-human trial

Background: Bioprosthesis has been increasingly implanted for the treatment of transvalvular disease across the world. A new Dafodil (TM) pericardial bioprosthesis (Meril Life Sciences Pvt Ltd., India) recently approved by Conformite Europeenne (CE) is a tri-leaflet stented, bovine valve. The purpose of Dafodil-1 first-in-human trial was to evaluate clinical safety and performance (including hemodynamic parameters) of the Dafodil pericardial bioprosthesis in patients who underwent aortic or mitral valve replacement. Methods: This prospective, multicenter clinical trial enrolled 60 patients (Aortic: 30 patients; Mitral: 30 patients) from seven sites across India. Safety endpoints were early (<= 30 days) and late (> 30 days) mortality and valve-related morbidity. The performance endpoints were hemodynamic performance, improvement in NYHA functional class, and change in the quality of life using SF-12v1 health survey. Results: From July 2017 to July 2018, 60 patients underwent implantation of the Dafodil pericardial bioprosthesis. Post-operatively, NYHA functional class significantly improved in all the patients (Aortic: 90% NYHA class-I and 10% NYHA class-II; Mitral: 96.55% NYHA class-I and 3.45% NYHA class-II; P < 0.001). There was no death in aortic valve replacement patients till 12-month. In mitral valve replacement patients, early mortalities occurred in three patients, and late mortality occurred in one patient; none of these were valve-related. Freedom from all-cause mortality reported was 93.33% at 12-month. Mean aortic pressure gradient decreased from 52.71 +/- 24.47 mmHg [with 0.89 +/- 0.70 cm(2) effective orifice area (EOA)] pre-operatively to 14.49 +/- 6.58 mmHg (EOA: 1.85 +/- 0.27 cm(2)) at 12-month. Overall, the mitral mean pressure gradient and EOA were 4.41 +/- 1.69 mmHg and 2.67 +/- 0.48 cm(2), respectively, at 12-month. Significant improvement (P < 0.05) in the patients' quality of life was reported at all follow-ups. Conclusions: The clinical safety and performance of the Dafodil pericardial bioprosthesis were favourable at 12-month. Moreover, a study with a larger patient population and longer follow-up is warranted to further assess the device.