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Clinical and hemodynamic assessment of the Hancock II bioprosthesis
T E David1, S Armstrong, Z Sun
1Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
Insights
The Hancock II bioprosthesis demonstrated favorable long-term outcomes in 614 patients undergoing heart valve replacement. This study highlights its effectiveness, especially for aortic valve replacement, showing improved functional class and survival rates.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- The Hancock II bioprosthesis is a commonly used device for heart valve replacement.
- Patient populations undergoing valve replacement often present with advanced New York Heart Association (NYHA) functional class.
Purpose of the Study:
- To evaluate the long-term clinical performance and outcomes of the Hancock II bioprosthesis in a large cohort of patients.
- To assess survival, freedom from complications, and functional status following aortic, mitral, and double valve replacement.
Main Methods:
- A retrospective analysis of 614 patients who received Hancock II bioprosthesis for heart valve replacement between 1982 and 1990.
- Data collection included operative details, perioperative mortality, long-term follow-up (mean 49 months), functional status, and specific event rates (stroke, endocarditis, reoperation).
- Actuarial survival and freedom from complications were calculated, and hemodynamic assessment was performed using Doppler echocardiography.
Main Results:
- Operative mortality ranged from 4% for aortic valve replacement (AVR) to 9% for double valve replacement (DVR).
- At 8 years, actuarial survival was 79% for AVR, 68% for MVR, and 65% for DVR.
- Freedom from stroke at 8 years was high (93% for AVR), and patients showed significant improvement in NYHA functional class post-operatively (85% in class I or II).
- Long-term freedom from endocarditis, primary tissue failure, and reoperation at 8 years was 96%, 92%, and 89%, respectively.
Conclusions:
- The Hancock II bioprosthesis provides gratifying clinical results and favorable long-term outcomes, particularly in the aortic position.
- The bioprosthesis is associated with good survival rates, low complication rates, and significant functional improvement in patients undergoing heart valve replacement.
- The Hancock II bioprosthesis is recommended as a preferred biological valve option based on these findings.
Abstract:
The Hancock II bioprosthesis was used for heart valve replacement in 614 patients from 1982 to 1990. Aortic valve replacement (AVR) was performed in 376 patients, mitral valve replacement (MVR) in 195, and aortic and mitral valve replacement (DVR) in 43. The mean age was 62.7 years, and 78% of all patients were in New York Heart Association functional class III or IV before operation. Coronary artery bypass graft was necessary in 232 patients and replacement of ascending aorta in 55. There were 31 operative deaths (AVR, 4%; MVR, 6%; DVR, 9%). Follow-up was complete in 98.5% of the patients and extended from 12 to 103 months, with a mean of 49 months. At the last follow-up, 85% of the patients were in New York Heart Association class I or II. The actuarial survival at 8 years was 79% +/- 3% for AVR, 68% +/- 4% for MVR, and 65% +/- 10% for DVR. The freedom from stroke at 8 years was 93% +/- 2% for AVR, 83% +/- 5% for MVR, and 90% +/- 5% for DVR. At the end of 8 years 96% +/- 1% of all patients were free from endocarditis, 92% +/- 1% were free from primary tissue failure, and 89% +/- 3% were free from reoperation. The actuarial freedom from valve-related death at 8 years was 98% +/- 1% for AVR, 86% +/- 5% for MVR, and 91% +/- 6% for DVR. Hemodynamic assessment was obtained by Doppler echocardiography in all operative survivors and demonstrated satisfactorily effective valve orifices and transvalvular gradients. The clinical results obtained with the Hancock II bioprosthesis have been gratifying, particularly in the aortic position. This bioprosthesis is our biological valve of choice.