Capturing echocardiographic allograft valve function over time after allograft aortic valve or root replacement

Abstract

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. 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. 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. 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.