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[Comparative analysis of Hancock and St. Jude Medical valve after mitral valve replacement]
T Kazui1, A Watanabe, M Morikawa
1Department of Surgery (Section 2), Sapporo Medical College & Hospital, Japan.
Insights
The St. Jude Medical (SJM) valve demonstrated superior long-term survival and fewer complications compared to the Hancock valve in mitral valve replacement (MVR) surgery. Hancock valves showed limited durability, necessitating more reoperations.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Mechanical heart valves are crucial for mitral valve replacement (MVR).
- Long-term comparative data on valve durability and patient outcomes are essential for clinical decision-making.
Purpose of the Study:
- To compare the long-term clinical outcomes and durability of Hancock and St. Jude Medical (SJM) valves following MVR.
Main Methods:
- A retrospective study comparing 81 patients with Hancock valves and 83 patients with SJM valves.
- Follow-up data spanning 709.0 patient-years for Hancock and 175.2 patient-years for SJM.
- Analysis of survival rates and valve-related complications, including thromboembolism, hemorrhage, paravalvular leak, infection, valve malfunction, and reoperation rates.
Main Results:
- The 7-year actuarial survival rate was significantly higher for the SJM group (93.9%) compared to the Hancock group (79.3%) (p < 0.01).
- Overall valve-related complications were significantly lower in the SJM group (91.1%) versus the Hancock group (58.9%) (p < 0.001).
- Reoperation rates for valve-related complications were significantly lower for SJM valves (100% event-free) compared to Hancock valves (83.1% event-free) (p < 0.01).
Conclusions:
- The St. Jude Medical valve offers superior long-term survival and reduced valve-related complications compared to the Hancock valve in MVR.
- While Hancock valves exhibit acceptable antithrombogenicity, their long-term durability is limited, leading to higher reoperation rates.
Abstract:
Long term results were compared in 81 operative survivors with MVR using Hancock valve (Hancock group) and 83 using St. Jude Medical valve (SJM group). The cumulative follow-up was 709.0 patients-year (p-y) and 175.2 p-y in the Hancock and SJM groups. Twenty-four percent of the patients in the Hancock group was permanently anticoagulated, while 100% of patients in the SJM group anticoagulated. The 7-year actuarial survival rate including early mortality was 79.3 +/- 4.6% for the Hancock and 93.9 +/- 3.0% for the SJM group (p less than 0.01). The survival rate was significantly higher in the SJM group than that in the Hancock group. The 7-year actuarial event free rate of the valve-related complications in the Hancock and SJM groups were as follows; thromboembolism 88.6 +/- 3.8% vs 95.0 +/- 2.8% (NS), hemorrhage, 94.0 +/- 3.0% vs 98.7 +/- 1.8% (NS), paravalvular leak 92.6 +/- 3.2% vs 97.4 +/- 1.8% (NS), infection 93.9 +/- 3.0% vs 100% (p less than 0.05), valve malfunction 78.0 +/- 5.2% vs 100% (p less than 0.001), overall valve related complications 58.9 +/- 5.9% vs 91.1 +/- 3.5% (p less than 0.001), reoperation for valve-related complication 83.1 +/- 4.6% vs 100% (p less than 0.01). The event free rate of reoperation for valve related complication in the Hancock group was significantly lower than that in the SJM group. The Hancock valve had the acceptable antithrombogenicity, but had the limited long-term durability.(ABSTRACT TRUNCATED AT 250 WORDS)