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[Primary failure of pericardial valvular heterografts]
Insights
Hancock pericardial valves showed a high incidence of primary tissue degeneration, leading to reoperation in 14.9% of patients. Regular clinical and echocardiographic follow-up is crucial for patients receiving these bioprosthetic valves.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Evaluation
Context:
- Hancock pericardial valves were implanted in 74 patients (mean age 64.2 years) between July 1981 and October 1984.
- Procedures included aortic valve replacement (52), mitral valve replacement (16), double replacement (5), and associated procedures (19).
Purpose:
- To evaluate the long-term efficacy and complications of Hancock pericardial valves.
- To assess the incidence of primary valve failure and the need for reoperation.
Summary:
- 11 primary failures (14.9%) required reoperation by June 1987, with reoperation times of 48.4 months (aortic) and 36.5 months (mitral).
- Common lesions included tears, calcifications, and stretching, indicating primary tissue degeneration.
- The actuarial rate of absence of primary lesions after 5 years was 85.3% +/- 8%, with faster dysfunction noted in mitral prostheses.
Impact:
- Results suggest Hancock pericardial valves have less favorable outcomes compared to Ionescu or porcine bioprostheses.
- Highlights the necessity for diligent clinical and echocardiographic monitoring of patients with these heterografts to detect early signs of degeneration.
Abstract:
From July 1981 to October 1984, 79 Hancock pericardial valves were implanted in 74 patients surviving the hospital period and with a mean age of 64.2 years. Fifty-two patients underwent aortic valve replacement, 16 had mitral valve replacement, 5 bad a double replacement and 19 associated procedures were performed. The mean survival is 48 months. Until 1st June 1987, 11 primary failures have required reoperation (14.9%), 4 in the mitral position (4.6% patient-years), 7 in the aortic position (3.01% patient-years). The time to reoperation was 48.4 months for the aortic orifice and 36.5 months for the mitral orifice. The lesions most frequently encountered were tears (7 cases), calcifications (5 cases) and stretching of valvular tissue (2 cases); two patients died during the postoperative phase of this operation. Despite the small number of patients followed, this series demonstrates of high incidence of dysfunction due to primary tissue degeneration as, after the 5th year, the actuarial rate of absence of primary lesion is 85.3 +/- 8% with no significant difference between the aortic and the mitral orifices, although dysfunction appears to occur more rapidly in mitral prostheses. These results are much less favourable than those obtained with Ionescu bioprostheses in the aortic position of those obtained with porcine bioprostheses in either position. This justifies very regular clinical and echocardiographic follow-up of patients with Hancock pericardial valvular heterografts.