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A 20-year experience with the Hancock porcine xenograft in the elderly
1Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. khan@csmc.edu
Insights
Elderly patients receiving a Hancock porcine valve have a low reoperation rate, with about 1 in 10 requiring reoperation within 15 years. Lifetime reoperation risk is less than 20% for these patients.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Geriatric Medicine
Background:
- Long-term data (20 years) on the Hancock porcine valve is available.
- This allows for the determination of long-term failure rates in elderly patients.
Purpose of the Study:
- To determine long-term actual and actuarial failure rates of the Hancock porcine valve in elderly patients.
- To compare these rates between elderly and younger patient groups.
Main Methods:
- Analysis of outcomes in 491 consecutive patients undergoing mitral or aortic valve replacement with the Hancock porcine valve.
- Comparison of actual and actuarial valve failure rates in elderly (≥65 years) versus younger patients.
Main Results:
- Median time to reoperation or structural failure was 15.9 years (aortic) and 14.3 years (mitral).
- 15-year actual reoperation rates were 10% (elderly aortic) vs. 30% (younger aortic) and 11% (elderly mitral) vs. 36% (younger mitral).
- Lifetime reoperation risk was ≤20% for elderly aortic and ≤18% for elderly mitral valve replacement patients.
Conclusions:
- Approximately 1 in 10 elderly patients receiving a Hancock valve require reoperation within 15 years.
- Less than 1 in 5 elderly patients will require reoperation in their lifetime.
Background:
The availability of 20 years of follow-up data on the Hancock porcine valve (Medtronic Inc, Irvine, CA) allows determination of long-term actual and actuarial failure rates in the elderly.
Methods:
We analyzed outcomes after mitral or aortic valve replacement with the Hancock porcine valve in 491 consecutive patients, comparing actual and actuarial valve failure rates in the elderly (age 65 or older) with those in younger patients.
Results:
The average age of aortic valve replacement recipients was 68+/-14 years (N = 243) and of mitral valve replacement recipients, 64+/-12 years (N = 248). Average follow-up was 7.0 years (1,673 patient-years) for aortic valve replacement and 7.3 years (1,781 patient years) for mitral valve replacement recipients. The median time to reoperation or structural failure was 15.9 years for aortic valve replacement patients and 14.3 years for mitral valve replacement patients. However, few elderly patients survived to 15 years (22% of the elderly aortic valve replacement and 13% of the older mitral valve replacement patients). The 15-year actual reoperation rate was therefore only 10% in the elderly aortic valve replacement compared to 30% in the younger aortic valve replacement patients. For mitral valve replacement, the 15-year actual reoperation rate was 11% in the elderly and 36% in the younger patients. The lifetime reoperation risk (the maximum potential number of patients who might ever undergo reoperation during their lifetime) is the sum of actual survival and actual reoperation rates. The lifetime reoperation risk was 20% or less for elderly aortic valve replacement patients and 18% or less for elderly mitral valve replacement patients.
Conclusion:
These data suggest that about 1 in 10 elderly patients (65 years or older) receiving a Hancock valve will require reoperation within 15 years and less than one in five will ever require reoperation in their lifetimes.