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Performance of the Hancock porcine bioprosthesis following aortic valve replacement: considerations based on a
A D Milano1, U Bortolotti, A Mazzucco
1Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
Insights
The Hancock porcine bioprosthesis (PB) shows satisfactory performance for aortic valve replacement up to 8 years. Beyond 10 years, primary tissue failure significantly impacts valve durability, necessitating careful patient selection.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomaterials Science
Background:
- Aortic valve replacement is a common procedure for severe aortic valve disease.
- Porcine bioprostheses (PB) have been widely used, but long-term durability is a concern.
Purpose of the Study:
- To evaluate the long-term performance and durability of the standard Hancock porcine bioprosthesis (PB) in patients undergoing isolated aortic valve replacement.
Main Methods:
- A retrospective review of 196 patients who received a Hancock PB between 1970 and 1983.
- Long-term follow-up (mean 6.6 years, up to 15.6 years) with 100% completeness.
- Analysis of actuarial survival, embolic episodes, reoperation rates, and primary tissue failure.
Main Results:
- Actuarial survival was 51% at 14 years.
- Freedom from emboli was 89.4% at 14 years.
- Primary tissue failure led to reoperation in 40 patients (3.5%/patient-year), with freedom from PB failure at 14 years being 34.3%.
Conclusions:
- The Hancock PB demonstrates acceptable performance for up to 8 years post-aortic valve replacement.
- Progressive deterioration due to primary tissue failure occurs beyond 10 years.
- Use of the Hancock PB in the aortic position should be restricted to selected patients due to long-term durability concerns.
Abstract:
All patients undergoing isolated aortic valve replacement with a standard Hancock porcine bioprosthesis (PB), from 1970 to 1983, were reviewed. There were 196 patients, 162 male and 34 female patients, with a mean age of 48 +/- 12 years. Operative survivors were followed up from 3 to 15.6 years (mean follow-up, 6.6 +/- 1.5 years), with a cumulative follow-up of 1,140 patient-years, being 100% complete. Actuarial survival was 51 +/- 15% at 14 years. Eight patients sustained systemic embolic episodes (0.7 +/- 0.2%/patient-year); actuarial freedom from emboli is 89.4 +/- 4.3% at 14 years. Reoperation was performed in 53 patients: in 6 because of endocarditis (0.5 +/- 0.2%/patient-year), in 7 because of perivalvular leak (0.6 +/- 0.2%/patient-year), and in 40 because of PB primary tissue failure (3.5 +/- 0.5%/patient-year). Actuarial freedom from PB-related deaths, PB failure, and overall PB-related complications at 14 years was 66.3 +/- 19, 34.3 +/- 11, and 30 +/- 10%, respectively. This long-term experience shows that the performance of the Hancock PB appears satisfactory up to 8 years, while it progressively deteriorates beyond 10 years because of the impact of primary tissue failure on valve durability, justifying the restriction of its use in the aortic position in selected patients.