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Hancock II bioprosthesis for aortic valve replacement: the gold standard of bioprosthetic valves durability?
Tirone E David1, Susan Armstrong, Manjula Maganti
1Division of Cardiovascular Surgery of Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
Insights
The Hancock II bioprosthesis demonstrates excellent long-term durability, particularly in patients aged 60 and older. This study confirms its status as a leading choice for bioprosthetic aortic valve replacement in this demographic.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Geriatric Medicine
Background:
- Assessing the long-term performance of the Hancock II bioprosthesis in aortic valve replacement (AVR).
- Evaluating durability across different patient age groups.
Purpose of the Study:
- To determine the long-term durability and functional outcomes of the Hancock II bioprosthesis in the aortic position.
- To compare valve performance in patients stratified by age.
Main Methods:
- Prospective monitoring of 1134 patients undergoing AVR with Hancock II bioprosthesis (1982-2004).
- Kaplan-Meier analysis for freedom from adverse events and structural valve deterioration.
- Assessment of valve function and need for reoperation.
Main Results:
- At 20 years, overall survival was 19.2%. Survival was significantly higher in younger patients (54.9% <60 years) compared to older groups.
- Freedom from structural valve deterioration at 20 years was 63.4% overall, but higher in older age groups (85.2% for 60-70 years, 99.8% for >70 years).
- Freedom from repeat AVR at 20 years was 65.1% overall, with significantly better outcomes in patients aged 60-70 (86.8%) and over 70 (98.3%).
Conclusions:
- The Hancock II bioprosthesis exhibits exceptional durability in patients aged 60 and older.
- It is considered a gold standard for bioprosthetic valve durability in this population.
- Younger patients (<60 years) experienced lower rates of freedom from structural valve deterioration and reoperation.
Background:
This study examined the long-term durability of the Hancock II bioprosthesis (Medtronic, Minneapolis, MN) in the aortic position.
Methods:
From 1982 to 2004, 1134 patients underwent aortic valve replacement (AVR) with Hancock II bioprosthesis and were prospectively monitored. Mean patient age was 67 +/- 11 years; 202 patients were younger than 60, 402 were 60 to 70, and 526 were older than 70. Median follow-up was 12.2 years and 99.2% complete. Valve function was assessed in 94% of patients. Freedom from adverse events was estimated by the Kaplan-Meier method.
Results:
Survival at 20 and 25 years was 19.2% +/- 2% and 6.7% +/- 2.8%, respectively, with only 34 and 3 patients at risk. Survival at 20 years was 54.9% +/- 6.4% in patients younger than 60 years, 22.7% +/- 3.3% in those 60 to 70, and 2.4% +/- 1.9% in those older than 70 (p = 0.01). Structural valve deterioration developed in 67 patients aged younger than 60, in 18 patients aged 60 to 70, and in 2 patients older than 70. The freedom from structural valve deterioration at 20 years was 63.4% +/- 4.2% in the entire cohort, 29.2% +/- 5.7% in patients younger than 60 years, 85.2% +/- 3.7% in patients aged 60 to 70, and 99.8% +/- 0.2% in patients older than 70 (truncated at 18 years). Repeat AVR was performed in 104 patients (74 for structural valve failure, 16 for endocarditis, and 14 for other reasons). At 20 years, the overall freedom from AVR was 65.1% +/- 4% for any reason, 29.8% +/- 5.4% in patients younger than 60 years, 86.8% +/- 3.3% in patients 60 to 70, and 98.3% +/- 0.6% in patients older than 70.
Conclusions:
Hancock II bioprosthesis is a very durable valve in patients 60 years and older and is probably the gold standard of bioprosthetic valve durability in this patient population.
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