Hemodynamic and clinical evaluation of the Hancock modified-orifice aortic bioprosthesis

Clinical experience with the Hancock porcine bioprosthetic heart valve was reviewed in 150 consecutive patients (82 men and 69 women), 13-83 years of age (mean 65 years and 65% older than 60 years), who underwent aortic valve replacement from February 1977 to December 1979. Thirty-eight percent of the patients had associated procedures, including aortocoronary bypass grafting (CABG), valvuloplasty and multiple valve replacement. Overall early mortality was 5% (eight of 150 patients): three of 98 who had isolated aortic valve replacement (AVR), two of 21 who had aortic and mitral valve replacement (AVR/MVR), one of 26 who had AVR/CABG and two four who had AVR/MVR/CABG. In a follow-up period of 6-42 months (mean 26 months), 10 patients have died. Predicted 3-year survival for the study population was 80%. Ninety percent of surviving patients in New York Heart Association functional class I. Incidence of emboli has been 1.5/100 patient-years. Of the five cases of endocarditis, three were fatal and all required reoperation. There have been no primary valve failures. In 43 patients, transvalvular intraoperative peak systolic gradients (left ventricular to aorta) were measured. In those with 19-mm valves (two patients), the gradient was 12.5 +/- 3.5 mm Hg; in those with 21-mm valves (16 patients), it was 10.0 +/- 6.5 mm Hg; in those with 23-mm valves (18 patients), it was 10.8 +/- 5.9 mm Hg; and in those with 25-mm valves (seven patients), it was 9.8 +/- 5.8 mm Hg. Thus, the Hancock modified orifice valve has good hydraulic performance and a low embolic rate without the need for anticoagulation, so it is acceptable for the elderly patient with a small aortic root.