The Hancock II bioprosthesis at 12 years

The Hancock II bioprosthesis has been used for heart valve replacement since 1982 in our institution. We previously reported its clinical performance at 8 years and at 10 years. This is a progress report on its performance at 12 years.

From 1982 to 1994 the Hancock II bioprosthesis was used for aortic valve replacement (AVR) in 723 patients and for mitral valve replacement (MVR) in 328 patients. The mean age of the patients was 65 years for both groups. Coronary artery disease was present in 42% of patients who had AVR and 45% of patients who had MVR. Patients have been followed up prospectively at annual intervals; the mean follow-up was 68+/-40 months for AVR and 66+/-43 months for MVR; it was 99% complete.

There were 36 (5%) operative and 159 late deaths in the AVR group, and 26 (8%) operative and 92 late deaths in the MVR. The actuarial survival at 12 years was 54%+/-4% for AVR and 42%+/-5% for MVR. Age greater than 65 years and coronary artery disease had a profound effect on late survival. At 12 years the freedom from thromboembolism was 86%+/-2% for AVR and 90% +/-2% for MVR; from endocarditis, 95%+/-1% for both groups; from primary tissue failure, 94%+/-2% for AVR and 82%+/-5% for MVR; and from valve reoperation, 89% +/-3% for AVR and 78%+/-5% for MVR. There was no primary tissue failure at 12 years in patients older than 65 years who had AVR.

The clinical performance of the Hancock II has been very satisfactory and this bioprosthesis appears to be more durable than its predecessors.