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J Thorac Cardiovasc Surg 2001;121:0268-0278
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Late results of heart valve replacement with the Hancock II bioprosthesis

From the Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.

Received for publication May 4, 2000. Revisions requested Aug 9, 2000; revisions received Aug 31, 2000. Accepted for publication Oct 12, 2000. Address for reprints: Tirone E. David, MD, 200 Elizabeth St, EN13-219, Toronto, Ontario, Canada M5G 2C4 (E-mail: tirone.david{at}uhn.on.ca).

Objective: To review the late clinical outcomes of patients who had isolated aortic or mitral valve replacement with the Hancock II bioprosthesis.
Methods: From 1982 to 1994, 670 patients underwent isolated aortic valve replacement and 310 underwent isolated mitral valve replacement with the Hancock II bioprosthesis (Medtronic Inc, Minneapolis, Minn). Mean age was 65 ± 12 years in both groups. Most patients were in New York Heart Association functional classes III or IV, and concomitant coronary artery disease was present in 44% of patients in the aortic valve group and 41% of patients in the mitral valve group. Patients were followed up prospectively at periodic intervals. Mean follow-up was 87 ± 45 months in the aortic valve group and 83 ± 50 months in the mitral valve group, and it was 99% complete.
Results: Actuarial survival at 15 years was 47% ± 3% in the aortic valve group and 30% ± 5% in the mitral valve group. Older age, advanced functional class, impaired left ventricular function, active endocarditis, and coronary artery disease were independent predictors of late death. The freedom from thromboembolic complications at 15 years was 83% ± 3% in the aortic and 87% ± 3% in the mitral valve group. The freedom from infective endocarditis at 15 years was 96% ± 1% in the aortic and 91% ± 1% in the mitral valve group. At 15 years, the actuarial and actual freedom from structural valve deterioration was 81% ± 5% and 90% ± 3%, respectively, in the aortic group and 66% ± 6% and 83% ± 3%, respectively, in the mitral group. Younger age, mitral valve position, and poor ventricular function were independent predictors of structural valve deterioration. The freedom from repeat valve replacement at 15 years was 77% ± 5% in the aortic group and 69% ± 6% in the mitral. The vast majority of patients had functional improvement after valve replacement.
Conclusions: The Hancock II bioprosthesis has provided good clinical outcomes and is a durable valve, particularly in the aortic position in older patients.