(Circulation. 2001;103:1515.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Human Tissue Valves in Aortic Position
Determinants of Reoperation and Valve Regurgitation
From the Departments of Cardiothoracic Surgery and Cardiology, Thoraxcenter, and the Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Correspondence to Lex A. van Herwerden, MD, PhD, Department of Cardiothoracic Surgery, Bd 156, Dijkzigt Hospital Rotterdam, Dr Molewaterplein 40, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail vanherwerden{at}thch.azr.nl
Background—Human tissue valves for aortic valve replacement have a limited durability that is influenced by interrelated determinants. Hierarchical linear modeling was used to analyze the relation between these determinants of durability and valve regurgitation measured by serial echocardiography.
Methods and Results—In adult patients, 218 cryopreserved aortic allografts were implanted with the subcoronary (85) or the root replacement technique (133), and 81 patients had root replacement with a pulmonary autograft. Mean follow-up was 4.2 years (SD 2.7; range, 0 to 10.5). Patient age, operator experience with subcoronary implantation, and allograft diameter were independent predictors for reoperation. With repeated color Doppler echocardiography, the severity of aortic regurgitation was assessed by the jet length method and the jet diameter ratio. Multilevel hierarchical linear modeling was used to estimate initial aortic regurgitation (intercept), its change over time (slope), and the effect of 11 potential determinants of durability on aortic regurgitation. With the jet length method, the intercept was 0.94 grade and the slope was 0.11 grade per year. With the jet diameter ratio, the intercept was 0.34 and the annual increase was 0.01. Subcoronary implanted valves had more initial aortic regurgitation, but progression of aortic valve regurgitation did not differ from root replacement. At midterm follow-up, recipient age <40 years was the only independent predictor of aortic regurgitation.
Conclusions—Subcoronary implantation has a learning curve, resulting in more initial aortic regurgitation and early reoperation compared with root replacement. In both techniques, progression of aortic regurgitation over time is small but accelerated in young adults.
Key Words: valves • aorta • echocardiography • epidemiology
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