{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:18:18Z","timestamp":1790641098407,"version":"4.1.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11_suppl_1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2009,9,15]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            Calcification is an important limitation after aortic root replacement. The aims were to compare the long-term degree and rate of calcification of homografts versus Medtronic freestyle aortic roots to determine the functional consequences and predictive factors.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            One hundred sixty-six patients were prospectively randomized to undergo homograft versus freestyle total aortic root replacement. Of those, 98 patients underwent a total of 248 electron beam computed tomography studies at 0.5, 1, 1.5, 2, 3, and 8 years. All patients underwent yearly clinical and echocardiographic follow-up. Calcium scores were measured using Agatston scoring. Mixed effects models demonstrate significantly higher calcium scores in homograft roots than freestyle at 1.5 years (\n            <jats:italic>P<\/jats:italic>\n            =0.02), 2 years (\n            <jats:italic>P<\/jats:italic>\n            =0.02), and 3 years (\n            <jats:italic>P<\/jats:italic>\n            =0.01), with a trend at 1 year (\n            <jats:italic>P<\/jats:italic>\n            =0.06) and 8 years (\n            <jats:italic>P<\/jats:italic>\n            =0.1). Homograft calcification occurs significantly faster than in freestyle prostheses between 6 months and 3 years after surgery (\n            <jats:italic>P<\/jats:italic>\n            =0.02). Calcification occurs at a similar rate thereafter up to 8 years (\n            <jats:italic>P<\/jats:italic>\n            =0.3). At 8 years, freedom from aortic valve dysfunction was lower in homografts than freestyle roots (\n            <jats:italic>P<\/jats:italic>\n            =0.06). Freedom from reoperation was 93\u00b14% in the homograft group versus 100\u00b10% in the freestyle group at 8 years (\n            <jats:italic>P<\/jats:italic>\n            =0.01). On multivariate analysis, redo surgery (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001), smoking (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.01), atrial fibrillation (\n            <jats:italic>P<\/jats:italic>\n            =0.001), family history of coronary artery disease (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.01), and a degenerative etiology (\n            <jats:italic>P<\/jats:italic>\n            =0.02) were predictive of higher calcium scores.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusion\u2014<\/jats:italic>\n            <\/jats:bold>\n            Homograft roots exhibit significantly higher calcium scores than freestyle roots because of faster early calcification.\n          <\/jats:p>","DOI":"10.1161\/circulationaha.108.843748","type":"journal-article","created":{"date-parts":[[2009,9,14]],"date-time":"2009-09-14T21:55:37Z","timestamp":1252965337000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Rate of Progression and Functional Significance of Aortic Root Calcification After Homograft Versus Freestyle Aortic Root Replacement"],"prefix":"10.1161","volume":"120","author":[{"given":"Ismail","family":"El-Hamamsy","sequence":"first","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Zaki","sequence":"additional","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis M.","family":"Stevens","sequence":"additional","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy A.","family":"Clark","sequence":"additional","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rubens","sequence":"additional","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Melina","sequence":"additional","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdi H.","family":"Yacoub","sequence":"additional","affiliation":[{"name":"From Department of Cardiac Surgery (I.E.-H., L.A.C., G.M., M.H.Y.) and Radiology (M.Z., M.R.), Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, UK; Harvard School of Public Health (L.M.S.), Harvard University, Boston, Mass."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000135469.82545.d0"},{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200008313430903"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.04.061"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.01.054"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2003.10.035"},{"key":"e_1_3_3_6_2","first-page":"361","volume":"10","year":"2001","unstructured":"Kizer JR, Gefter WB, deLemos AS, Scoll BJ, Wolfe ML, Mohler ER III. 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