{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:31:50Z","timestamp":1771921910473,"version":"3.50.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Subaortic pannus overgrowth is a recognized complication following aortic valve replacement (AVR) with mechanical prostheses, potentially requiring reoperation. Since data on its incidence and risk factors remain scarce, this study aimed to determine the incidence and risk factors for subaortic pannus overgrowth after AVR with bileaflet mechanical valves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 1145 patients who underwent AVR with bileaflet mechanical valves between 1995 and 2010 at a cardiac referral centre. Subaortic pannus overgrowth was defined by imaging evidence causing clinical stenosis and confirmed intraoperatively. Cumulative incidence was estimated using competing risks analysis, and risk factors were identified using Fine and Gray models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a mean follow-up of 16.5 years, 47 patients (4.1%) developed subaortic pannus overgrowth requiring reoperation (mean interval 13.6 years). The 10- and 20-year cumulative incidence was 1.1% and 5.0%, respectively. Multivariable analysis identified female sex (hazard ratio [HR]: 2.18), smaller prosthetic valve size (21 mm vs \u226523 mm, HR: 8.62, and \u226419 mm vs \u226523 mm, HR: 12.02), and concomitant mitral valve replacement (HR: 2.63) as independent risk factors. Older age at AVR was protective (HR: 0.69 per 10-year increase). Recurrence occurred in 1 patient after isolated pannus resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Subaortic pannus overgrowth is a late complication after bileaflet mechanical AVR, with a gradually increasing incidence. Female sex, smaller prosthesis size, younger age, and concomitant mitral valve replacement are significant risk factors. Complete pannus removal and valve replacement should be considered during reoperation. Further research into the underlying mechanisms is warranted for prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf363","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:34:49Z","timestamp":1761046489000},"source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Incidence and Risk Factors of Subaortic Pannus Overgrowth After Bileaflet Mechanical Aortic Valve Replacement"],"prefix":"10.1093","volume":"67","author":[{"given":"Hung Dung","family":"Van","sequence":"first","affiliation":[{"name":"Heart Institution of Ho Chi Minh City Cardiac Surgery Department, , 4 Duong Quang Trung Street, Ward Hoa Hung , Ho Chi Minh City 700000, Vietnam"},{"name":"Pham Ngoc Thach University of Medicine Department of Thoracic and Cardiovascular Surgery, , 2 Duong Quang Trung Street, Ward Hoa Hung , Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minh Chau","family":"Van Nguyen","sequence":"additional","affiliation":[{"name":"Open Polytechnic Analyst and Strategic Insights Department, , 3 Cleary Street , Lower Hutt 5011,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dang Huu","family":"Danh","sequence":"additional","affiliation":[{"name":"Heart Institution of Ho Chi Minh City Cardiac Surgery Department, , 4 Duong Quang Trung Street, Ward Hoa Hung , Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2684-3041","authenticated-orcid":false,"given":"Nguyen Lam","family":"Vuong","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy at Ho Chi Minh City Department of Medical Statistics and Informatics, Faculty of Public Health, , 217 Hong Bang Street, Ward Cho Lon , Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"2025111001100460700_ezaf363-B1","doi-asserted-by":"crossref","first-page":"S343","DOI":"10.21037\/jtd.2017.04.14","article-title":"Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves","volume":"9","author":"Aladmawi","year":"2017","journal-title":"J Thorac Dis"},{"key":"2025111001100460700_ezaf363-B2","doi-asserted-by":"crossref","first-page":"104","DOI":"10.2174\/1874192420130902001","article-title":"Type of valvular heart disease requiring surgery in the 21st century: mortality and length-of-stay related to surgery","volume":"7","author":"Boudoulas","year":"2013","journal-title":"Open Cardiovasc Med J"},{"key":"2025111001100460700_ezaf363-B3","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/096721090201000409","article-title":"Obstruction of St Jude medical valves in the aortic position: a consideration for pathogenic mechanism of prosthetic valve obstruction","volume":"10","author":"Aoyagi","year":"2002","journal-title":"Cardiovasc Surg"},{"key":"2025111001100460700_ezaf363-B4","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1253\/circj.CJ-18-0352","article-title":"Clinical outcomes of repeat aortic valve replacement for subaortic pannus in mechanical aortic valve","volume":"82","author":"Park","year":"2018","journal-title":"Circ J"},{"key":"2025111001100460700_ezaf363-B5","first-page":"591","article-title":"Reoperation for non-structural valvular dysfunction caused by pannus ingrowth in aortic valve prosthesis","volume":"22","author":"Oh","year":"2013","journal-title":"J Heart Valve Dis"},{"key":"2025111001100460700_ezaf363-B6","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S0022-5223(03)00702-5","article-title":"Obstruction of St Jude medical valves in the aortic position: histology and immunohistochemistry of pannus","volume":"126","author":"Teshima","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025111001100460700_ezaf363-B7","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/S0003-4975(96)01391-4","article-title":"Obstruction of mechanical mitral prostheses: analysis of pathologic findings","volume":"63","author":"Vitale","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"2025111001100460700_ezaf363-B8","first-page":"301","article-title":"Enlargement of the aortic annulus by resecting the commissure between the left and noncoronary cusps","volume":"10","author":"Nu\u00f1ez","year":"1983","journal-title":"Tex Heart Inst J"},{"key":"2025111001100460700_ezaf363-B9","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S0022-5223(19)39673-4","article-title":"A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring","volume":"70","author":"Konno","year":"1975","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025111001100460700_ezaf363-B10","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"key":"2025111001100460700_ezaf363-B11","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/S1010-7940(99)00124-4","article-title":"Reoperations for acute prosthetic thrombosis and pannus: an assessment of rates, relationship and risk","volume":"16","author":"Rizzoli","year":"1999","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025111001100460700_ezaf363-B12","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s10047-006-0334-3","article-title":"Prevalence of pannus formation after aortic valve replacement: clinical aspects and surgical management","volume":"9","author":"Sakamoto","year":"2006","journal-title":"J Artif Organs"},{"key":"2025111001100460700_ezaf363-B13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s10047-003-0226-8","article-title":"Pannus formation in aortic valve prostheses in the late postoperative period","volume":"6","author":"Kuniyoshi","year":"2003","journal-title":"J Artif Organs"},{"key":"2025111001100460700_ezaf363-B14","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1055\/s-0041-1727152","article-title":"Incidence and risk factors of pannus after mechanical aortic valve replacement","volume":"70","author":"Choi","year":"2022","journal-title":"Thorac Cardiovasc Surg"},{"key":"2025111001100460700_ezaf363-B15","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1148\/radiol.2015142400","article-title":"Subprosthetic pannus after aortic valve replacement surgery: cardiac CT findings and clinical features","volume":"276","author":"Han","year":"2015","journal-title":"Radiology"},{"key":"2025111001100460700_ezaf363-B16","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/j.jcmg.2014.12.036","article-title":"Real-time 3D TEE for diagnosis of subvalvular pannus formation in mechanical aortic valves: comparison with multidetector CT and surgical findings","volume":"8","author":"Lee","year":"2015","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025111001100460700_ezaf363-B17","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/S1010-7940(03)00568-2","article-title":"Surgery for prosthetic valve obstruction. A single center study of 136 patients","volume":"24","author":"Roudaut","year":"2003","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025111001100460700_ezaf363-B18","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1525-1594.2009.00800.x","article-title":"Obstruction of St. Jude medical valves in the aortic position: plasma transforming growth factor type beta 1 in patients with pannus overgrowth","volume":"34","author":"Teshima","year":"2010","journal-title":"Artif Organs"},{"key":"2025111001100460700_ezaf363-B19","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1136\/hrt.2005.067363","article-title":"Prosthesis-patient mismatch: definition, clinical impact, and prevention","volume":"92","author":"Pibarot","year":"2006","journal-title":"Heart"},{"key":"2025111001100460700_ezaf363-B20","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S0894-7317(97)70026-9","article-title":"Normal echocardiographic characteristics of the Sorin bicarbon bileaflet prosthetic heart valve in the mitral and aortic positions","volume":"10","author":"Badano","year":"1997","journal-title":"J Am Soc Echocardiogr"},{"key":"2025111001100460700_ezaf363-B21","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.athoracsur.2004.10.002","article-title":"Comparative evaluation of small-size Sorin Slimline and St. Jude HP heart valve prostheses","volume":"79","author":"Otero","year":"2005","journal-title":"Ann Thorac Surg"},{"key":"2025111001100460700_ezaf363-B22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.athoracsur.2010.10.039","article-title":"Serial changes of hemodynamic performance with Medtronic Hall valve in aortic position","volume":"91","author":"Cho","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2025111001100460700_ezaf363-B23","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.ijcard.2011.11.105","article-title":"Long-term hemodynamic performance of bileaflet prostheses versus tilting-disc prostheses in the aortic position","volume":"166","author":"Jeong","year":"2013","journal-title":"Int J Cardiol"},{"key":"2025111001100460700_ezaf363-B24","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s13019-019-1022-8","article-title":"Early clinical outcomes of simple pannus removal for mechanical aortic valve stenosis","volume":"14","author":"Cui","year":"2019","journal-title":"J Cardiothorac Surg"},{"key":"2025111001100460700_ezaf363-B25","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/1749-8090-7-62","article-title":"Recurrent pannus formation causing prosthetic aortic valve dysfunction: is excision without valve re-replacement applicable?","volume":"7","author":"Darwazah","year":"2012","journal-title":"J Cardiothorac Surg"},{"key":"2025111001100460700_ezaf363-B26","first-page":"2321","article-title":"Dysfunction of mechanical heart valve prosthesis: experience with surgical management in 48 patients","volume":"7","author":"Ma","year":"2015","journal-title":"J Thorac Dis"},{"key":"2025111001100460700_ezaf363-B27","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1016\/j.athoracsur.2013.07.019","article-title":"Acute obstruction by pannus in patients with aortic Medtronic-Hall valves: 30 years of experience","volume":"96","author":"Ellensen","year":"2013","journal-title":"Ann Thorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf363\/64883369\/ezaf363.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/11\/ezaf363\/64883369\/ezaf363.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/11\/ezaf363\/64883369\/ezaf363.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:10:09Z","timestamp":1762755009000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf363\/8300294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":27,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf363","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,10,23]]},"article-number":"ezaf363"}}