title: Capturing echocardiographic allograft valve function over time after allograft aortic valve or root replacement.
abstract: OBJECTIVE
  This study describes echocardiographic allograft valve function over time in a cohort of patients who were prospectively followed after allograft aortic valve or root replacement, illustrating the use of longitudinal data analysis for assessing valve function over time.
  
  
  METHODS
  Serial, standardized echocardiographic measurements of aortic regurgitation, aortic gradient, annulus diameter, left ventricular outflow tract diameter, and aortic diameter in 301 hospital survivors (mean age, 46 years; range, 16-83 years) after allograft aortic valve (N=77) or root (N=224) replacement were analyzed using nonlinear longitudinal models.
  
  
  RESULTS
  Aortic regurgitation increased over time. At 15 years, 41% of patients had at least moderate aortic regurgitation. Younger patient age and subcoronary implantation technique were associated with increased aortic regurgitation. Aortic gradient increased over time (from 9.4 mm Hg at 6 months to 21.3 mm Hg at 15 years); both initial and increase in aortic gradient were greater in younger patients and after subcoronary implantation technique. Annulus diameter slightly increased (from 21.9 mm at 6 months to 22.4 mm at 15 years), whereas aortic diameter slightly decreased over time (from 34.3 mm at 6 months to 32.7 mm at 15 years). Left ventricular outflow tract diameter remained constant at 22 mm. Younger patients in the subcoronary implantation group had a larger annulus diameter.
  
  
  CONCLUSIONS
  Both aortic regurgitation and stenosis increase over time after allograft aortic valve or root replacement. Younger patient age and use of the subcoronary implantation technique are associated with increased regurgitation and stenosis. The use of nonlinear longitudinal models allows for an insightful analysis of allograft valve function over time.
authors: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: m.mokhles@erasmusmc.nl.
authors: M Mostafa
authors: MM
authors: Mokhles
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Jeevanantham
authors: J
authors: Rajeswaran
authors: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Jos A
authors: JA
authors: Bekkers
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Gerard J J M
authors: GJ
authors: Borsboom
authors: Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Jolien W
authors: JW
authors: Roos-Hesselink
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Ad J J C
authors: AJ
authors: Bogers
authors: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Johanna J M
authors: JJ
authors: Takkenberg
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors: Eugene H
authors: EH
authors: Blackstone
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult