{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:34:59Z","timestamp":1790836499937,"version":"4.1.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2018,9,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The incidence of structural valve deterioration after bioprosthesis (BP) aortic valve replacement (AVR) established on the basis of reoperation may substantially underestimate the true incidence. The objective is to determine the rate, timing, correlates, and association between hemodynamic valve deterioration (HVD) and outcomes assessed by Doppler echocardiography after surgical BP AVR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A total of 1387 patients (62.2% male, 70.5\u00b17.8 years of age) who underwent BP AVR were included in this retrospective study. Baseline echocardiography was performed at a median time of 4.1 (1.3\u20136.5) months after AVR. All patients had an echocardiographic follow-up \u22652 years after AVR (926 at least 5 years and 385 at least 10 years). HVD was defined by Doppler assessment as a \u226510 mm\u2009Hg increase in mean gradient or worsening of transprosthetic regurgitation \u22651\/3 class. HVD was classified according to the timing after AVR: \u201cvery early,\u201d during the first 2-years; \u201cearly,\u201d between 2 and 5 years; \u201cmidterm,\u201d between 5 and 10 years; and \u201clong-term,\u201d &gt;10 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              A total of 428 patients (30.9%) developed HVD. Among these patients, 52 (12.0%) were classified as \u201cvery early,\u201d 129 (30.1%) as \u201cearly,\u201d 158 (36.9%) as \u201cmidterm,\u201d and 89 (20.8%) as \u201clong-term\u201d HVD. Factors independently associated with HVD occurring within the first 5 years after AVR were diabetes mellitus (\n              <jats:italic>P<\/jats:italic>\n              =0.01), active smoking (\n              <jats:italic>P<\/jats:italic>\n              =0.01), renal insufficiency (\n              <jats:italic>P<\/jats:italic>\n              =0.01), baseline postoperative mean gradient \u226515 mm\u2009Hg (\n              <jats:italic>P<\/jats:italic>\n              =0.04) or transprosthetic regurgitation \u2265mild (\n              <jats:italic>P<\/jats:italic>\n              =0.04), and type of BP (stented versus stentless,\n              <jats:italic>P<\/jats:italic>\n              =0.003). Factors associated with HVD occurring after the fifth year after AVR were female sex (\n              <jats:italic>P<\/jats:italic>\n              =0.03), warfarin use (\n              <jats:italic>P<\/jats:italic>\n              =0.007), and BP type (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). HVD was independently associated with mortality (hazard ratio, 2.18; 95% CI, 1.86\u20132.57;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>HVD as identified by Doppler echocardiography occurred in one third of patients and was associated with a 2.2-fold higher adjusted mortality. Diabetes mellitus and renal insufficiency were associated with early HVD, whereas female sex, warfarin use, and stented BPs (versus stentless) were associated with late HVD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.118.035150","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T18:06:24Z","timestamp":1537207584000},"page":"971-985","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":118,"title":["Rate, Timing, Correlates, and Outcomes of Hemodynamic Valve Deterioration After Bioprosthetic Surgical Aortic Valve Replacement"],"prefix":"10.1161","volume":"138","author":[{"given":"Erwan","family":"Salaun","sequence":"first","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)"},{"name":"Centre de R\u00e9sonance Magn\u00e9tique Biologique et M\u00e9dicale, Centre National de la Recherche Scientifique, Aix-Marseille Universit\u00e9, France (E.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha\u00effa","family":"Mahjoub","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"INSERM, Centre d\u2019Investigations Cliniques, Universit\u00e9 de Lorraine, CHU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, France (N.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Dagenais","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de 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