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Heart valve replacement with the Hancock bioprosthesis: a 6-year review
Insights
This study reviewed Hancock valve replacements in 632 patients between 1974-1979. Glutaraldehyde xenografts showed promising safety and efficacy for mitral and aortic valve replacement, supporting continued use.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- The Hancock bioprosthesis, a glutaraldehyde-preserved xenograft, was utilized for mitral and aortic valve replacements.
- Understanding the long-term performance and safety of these bioprostheses is crucial for patient management.
Purpose of the Study:
- To evaluate the hospital mortality, late mortality, thromboembolic rates, and valve failure rates associated with Hancock valve replacements.
- To assess the overall efficacy and safety of glutaraldehyde xenografts in cardiac valve surgery.
Main Methods:
- A retrospective review of 734 Hancock valve implantations in 632 patients between June 1974 and June 1979.
- Analysis of hospital mortality, follow-up data (1-6 years), late mortality, thromboembolic events, and valve failure modes.
Main Results:
- Hospital mortality varied by procedure: 9.6% for mitral (MVR), 4.6% for aortic (AVR), and 13.7% for combined (MVR + AVR).
- Late mortality per patient-year was 0.96% (MVR), 1.53% (AVR), and 2.08% (MVR + AVR).
- Valve failure rates per patient-year were 0.53% (MVR), 0.13% (AVR), and 2.08% (MVR + AVR), with common causes including rupture and thrombosis.
Conclusions:
- The Hancock bioprosthesis demonstrated acceptable safety and efficacy, with low rates of thromboembolism and valve failure, particularly for aortic valve replacement.
- The study supports the continued routine use of glutaraldehyde xenografts as a safe valve substitute in cardiac surgery.
Abstract:
All patients who had a mitral or aortic Hancock valve replacement between June, 1974, and June, 1979, were reviewed. A total of 734 bioprostheses were implanted in 632 patients: 291 had mitral (MVR), 239 had aortic (AVR), and 102 had both mitral and aortic valve replacement (MVR + AVR). In 228 patients, an associated surgical procedure was necessary. It involved conservative valve operation in 205 of them. The hospital mortality was 9.6% (28) for MVR (11.5% with associated operation), 4.6% (11) for AVR (8.7% with associated operation), and 13.7% (14) for MVR + AVR (13.0% with associated operation). The follow-up period was between 1 and 6 years with a total follow-up of 934.6, 714.6, and 288.3 patient-years for MVR, AVR and MVR + AVR, respectively. The late mortality was 0.96% (9), 1.53% (11), and 2.08% (6) per patient-year for MVR, AVR, and MVR + AVR, respectively. The thromboembolic rate was 1.49%, 0.14%, and 2.08% per patient-year for MVR, AVR, and MVR + AVR, respectively. There were twelve valve failure (six wer due to rupture; four, thrombosis; one, insufficiency because of intrinsic failure; and one, stenosis without evident cause at reoperation). This represents a failure rate of 0.53%, 0.13%, and 2.08% per patient-year for MVR, AVR, and MVR + AVR, respectively. These results encourage us to continue our routine use of the glutaraldehyde xenografts as the safest valve substitute at present.