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Echocardiographic and pathologic features of explanted Hancock and Carpentier-Edwards bioprosthetic valves in the

T Z Naqvi1, R J Siegel, N A Buchbinder

  • 1Department of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine, Los Angeles, California 90048, USA. tasneem.naqvi@cshs.org

The American Journal of Cardiology
|December 22, 1999
PubMed

Insights

Failure modes of Hancock and Carpentier-Edwards (C-E) porcine mitral valves differ. Hancock valves showed more stenosis and stent creep, while C-E valves had dehiscence at stent posts, with anterior leaflet degeneration common in both.

Area of Science:

  • Cardiovascular Surgery
  • Biomaterials Science
  • Pathology

Background:

  • Porcine bioprosthetic valves are widely used for mitral valve replacement.
  • Understanding failure modes is crucial for improving valve design and patient outcomes.
  • Hancock and Carpentier-Edwards (C-E) valves are common types with distinct designs.

Purpose of the Study:

  • To investigate and compare the modes of failure for Hancock and C-E porcine bioprosthetic valves in the mitral position.
  • To identify specific pathological features associated with degeneration in each valve type.

Main Methods:

  • Retrospective review of transesophageal echocardiography (n=19) and explanted valve pathology (n=30).
  • Analysis of failed Hancock (n=22) and C-E (n=8) porcine mitral valves.
  • Comparison of patient demographics, implantation details, and explant findings.

Main Results:

  • No significant differences in age at implantation, time to degeneration, or bioprosthesis size between Hancock and C-E valves.
  • Anterior leaflet degeneration was the most frequent failure mode (p=0.0004).
  • Hancock valves exhibited higher rates of stenosis (p=0.06) and stent creep (p=0.0013).
  • C-E valves showed a higher incidence of large commissural dehiscence (p=0.0006) and dehiscence at stent posts (p<0.001).
  • Ring margin perforation was common in Hancock valves; dehiscence at stent posts was most common in C-E valves.

Conclusions:

  • Valve design appears to influence the specific mechanisms of porcine mitral valve degeneration.
  • Hancock valves are prone to stenosis and stent creep, whereas C-E valves may experience more dehiscence at stent posts.
  • Anterior leaflet degeneration is a common pathway for failure in both Hancock and C-E mitral bioprosthetic valves.

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