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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
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.
Abstract:
Modes of failure of Hancock and Carpentier-Edwards (C-E) porcine bioprosthetic valves placed in the mitral position are not completely understood. We reviewed transesophageal echocardiographic (n = 19) and pathologic features of failed Hancock (n = 22) and C-E (n = 8) porcine mitral valves in 30 patients (mean age 70 +/- 13 years). Age at implantation (59 +/- 14 vs 58 +/-14 years, p = 0.9), time to implanted valve degeneration (13 +/- 5 vs 11 +/- 2 years, p = 0.3), and size of bioprosthesis (30 +/- 2 vs 31 +/- 2 mm, p = 0.14) of the implanted Hancock and C-E valves were similar. Anterior leaflet was flail in 15 versus flail posterior leaflet in 5 patients (p = 0.0004). Eccentric posterior mitral regurgitation jet was present in 12, eccentric anterior jet in 2, central jet in 2, and paravalvular jet in 3 patients. Stenosis of bioprosthesis was present in 1 1 Hancock versus 1 C-E valve (p = 0.06). Stent creep at any stent post was present in 14 Hancock versus no C-E valve (p = 0.0013). Large commissural dehiscence was present in 5 C-E versus 1 Hancock valve (p = 0.0006). Ring margin perforation was the most common perforation in Hancock valves (p <0.05, analysis of variance versus all other Hancock perforations). Dehiscence at the stent posts was the most common perforation in C-E valves (p <0.05 vs other C-E perforations, analysis of variance and p <0.001 versus Hancock valves). Thus, Hancock valves showed greater stenosis and stent creep, whereas C-E valves showed large dehiscences at the stent posts on explantation. The anterior leaflet degenerated most frequently in both valves. These findings suggest that the valve design may influence the mechanisms of porcine valve degeneration.