Comparison of Hancock I and Hancock II bioprostheses.
The Hancock II bioprosthesis was developed in order to provide the advantageous low pressure fixation, improved delrin stent design, and anticalcification treatment. These changes were made 6 years ago after 10 years of experience with the high pressure fixed rigid implantation ring and polypropylene stent used in the Hancock I valve. In 1983, based on our own experience with low pressure fixed valves in 76 patients, we began early clinical trials with the Hancock II valve. All valves were studied postoperatively by intraoperative catheterization and followed up with postoperative echocardiograms for measurement of valve gradients and areas. This series of 104 patients with Hancock II valves was then compared retrospectively with 119 patients receiving Hancock I valves from 1975 to 1983. A comparison of mortality, thromboembolism, and hemorrhage rates was not significantly different between groups and the valve failure incidence of Hancock I valves was an anticipated 2.34% per patient-year. There has been one primary tissue failure in the Hancock II series. This patient had fibrinous excrescences on the outflow surface of the valve in the aortic position. These nodules were compatible with an old thrombotic process of ill-defined nature. Further investigation resulted in reports of this phenomenon, which had resulted in early valve stenosis, from other centers implanting the Hancock II valve. In conclusion, the Hancock II bioprosthesis has theoretical advantages over the Hancock I in stent design, fixation pressure, and anticalcification potential. There is an unusual thrombotic process in aortic valve replacements that we have not observed in the Hancock I group or in our experience with other porcine xenografts.(ABSTRACT TRUNCATED AT 250 WORDS)
Oury
J H
JH
Division of Cardiac Surgery, Scripps Clinic and Research Foundation, La Jolla, California.
Angell
W W
WW
Koziol
J A
JA
D000368:Aged; D001021:Aortic Valve; D001705:Bioprosthesis / Q000592:standards*; D002140:California / Q000453:epidemiology; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D006439:Hemodynamics; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011184:Postoperative Period; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015996:Survival Rate