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Late results of heart valve replacement with the Hancock II bioprosthesis
T E David1, J Ivanov, S Armstrong
1Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
Insights
The Hancock II bioprosthesis shows good long-term durability and clinical outcomes in aortic and mitral valve replacement patients. This bioprosthetic valve is particularly effective in the aortic position for older individuals, offering functional improvement.
Area of Science:
- Cardiovascular Surgery
- Bioprosthetic Heart Valves
- Clinical Outcomes Research
Background:
- The Hancock II bioprosthesis is a commonly used option for aortic and mitral valve replacement.
- Understanding the long-term performance and durability of bioprosthetic valves is crucial for patient management.
Purpose of the Study:
- To evaluate the late clinical outcomes and durability of the Hancock II bioprosthesis in patients undergoing isolated aortic or mitral valve replacement.
Main Methods:
- A prospective study of 670 patients with aortic valve replacement and 310 with mitral valve replacement using the Hancock II bioprosthesis.
- Mean follow-up was over 80 months, with near-complete patient follow-up.
Main Results:
- 15-year survival was 47% for aortic and 30% for mitral valve replacement.
- Freedom from structural valve deterioration at 15 years was 81% (aortic) and 66% (mitral).
- The majority of patients experienced functional improvement post-surgery.
Conclusions:
- The Hancock II bioprosthesis demonstrates good clinical outcomes and durability, especially in the aortic position for older patients.
- Factors like age, valve position, and ventricular function influence structural valve deterioration.
Objective:
To review the late clinical outcomes of patients who had isolated aortic or mitral valve replacement with the Hancock II bioprosthesis.
Methods:
From 1982 to 1994, 670 patients underwent isolated aortic valve replacement and 310 underwent isolated mitral valve replacement with the Hancock II bioprosthesis (Medtronic Inc, Minneapolis, Minn). Mean age was 65 +/- 12 years in both groups. Most patients were in New York Heart Association functional classes III or IV, and concomitant coronary artery disease was present in 44% of patients in the aortic valve group and 41% of patients in the mitral valve group. Patients were followed up prospectively at periodic intervals. Mean follow-up was 87 +/- 45 months in the aortic valve group and 83 +/- 50 months in the mitral valve group, and it was 99% complete.
Results:
Actuarial survival at 15 years was 47% +/- 3% in the aortic valve group and 30% +/- 5% in the mitral valve group. Older age, advanced functional class, impaired left ventricular function, active endocarditis, and coronary artery disease were independent predictors of late death. The freedom from thromboembolic complications at 15 years was 83% +/- 3% in the aortic and 87% +/- 3% in the mitral valve group. The freedom from infective endocarditis at 15 years was 96% +/- 1% in the aortic and 91% +/- 1% in the mitral valve group. At 15 years, the actuarial and actual freedom from structural valve deterioration was 81% +/- 5% and 90% +/- 3%, respectively, in the aortic group and 66% +/- 6% and 83% +/- 3%, respectively, in the mitral group. Younger age, mitral valve position, and poor ventricular function were independent predictors of structural valve deterioration. The freedom from repeat valve replacement at 15 years was 77% +/- 5% in the aortic group and 69% +/- 6% in the mitral. The vast majority of patients had functional improvement after valve replacement.
Conclusions:
The Hancock II bioprosthesis has provided good clinical outcomes and is a durable valve, particularly in the aortic position in older patients.