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Extended follow-up of the standard Hancock porcine bioprosthesis
U Bortolotti1, A Milano, A Mazzucco
1Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
Insights
This study evaluates the Hancock porcine bioprosthesis (HPB) in 665 patients undergoing aortic and mitral valve replacement. Long-term results show significant structural deterioration and lower survival rates, particularly after mitral valve replacement.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Valve Research
Background:
- The Hancock porcine bioprosthesis (HPB) has been utilized for heart valve replacement since the 1970s.
- Assessing the long-term performance and complications of early bioprosthetic valves is crucial for understanding their durability and patient outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy and complications associated with the standard Hancock porcine bioprosthesis (HPB) in patients undergoing aortic and mitral valve replacement.
- To analyze survival rates and freedom from specific complications such as thromboembolism, hemorrhage, endocarditis, prosthetic leak, and structural deterioration.
Main Methods:
- A retrospective review of 665 patients who received the HPB for aortic valve replacement (AVR), mitral valve replacement (MVR), or combined mitral and aortic valve replacement (MAVR) between 1970 and 1983.
- Actuarial analysis was performed to determine survival rates and freedom from complications over extended follow-up periods (up to 16-18 years).
Main Results:
- After AVR (n=173), long-term structural deterioration occurred in 4.3% per patient-year, with a 16-year survival of 40%.
- After MVR (n=437), structural deterioration was observed in 4.0% per patient-year, and 18-year survival was 33%.
- Freedom from thromboembolic episodes was notably lower after MVR (57% at 18 years) compared to AVR (89% at 16 years).
Conclusions:
- The Hancock porcine bioprosthesis demonstrated significant rates of structural deterioration, impacting long-term survival, especially following mitral valve replacement.
- While effective in the short term, the durability limitations of early bioprosthetic valves like the HPB necessitate ongoing research into improved valve technologies.
Abstract:
We have reviewed 665 patients in whom the standard Hancock porcine bioprosthesis (HPB) was used for aortic (AVR = 173), mitral (MVR = 437), and mitral and aortic (MAVR = 55) valve replacement in the time interval from 1970 to 1983. After AVR, HPB-related deaths occurred in 24 patients (1.7% +/- 0.4% per patient-year); 11 had thromboembolic episodes (0.8% +/- 0.2% per patient-year), 6 hemorrhages related to anticoagulants (0.4% +/- 0.2% per patient-year), 9 endocarditis (0.7% +/- 0.2% per patient-year), 7 prosthetic leak (0.5% +/- 0.1% per patient-year), and 59 structural deterioration (4.3% +/- 0.6% per patient-year). At 16 years, actuarial survival is 40% +/- 6%, freedom from thromboembolic episodes 89% +/- 4%, from hemorrhages 90% +/- 5%, from endocarditis 94% +/- 2%, from prosthetic leak 95% +/- 2%, and from structural deterioration 36% +/- 6%. After MVR, HPB-related deaths occurred in 64 patients (1.6% +/- 0.2% per patient-year); 68 had thromboembolic episodes (1.7% +/- 0.2% per patient-year), 28 hemorrhages (0.7% +/- 0.1% per patient-year), 12 endocarditis (0.3% +/- 0.1% per patient-year), 9 prosthetic leak (0.2% +/- 0.1% per patient-year), and 158 structural deterioration (4.0% +/- 0.3% per patient-year). At 18 years, actuarial survival is 33% +/- 4%, freedom from thromboembolic episodes 57% +/- 13%, from hemorrhages 81% +/- 6%, from endocarditis 91% +/- 4%, from prosthetic leak 98% +/- 1%, and from structural deterioration 18% +/- 5%.(ABSTRACT TRUNCATED AT 250 WORDS)