title: Over twenty-year follow-up of the standard Hancock porcine bioprosthesis implanted in the mitral position.
abstract: BACKGROUND
  To define the long-term results of 331 standard Hancock porcine bioprostheses implanted in the mitral position between 1973 and 1980.
  
  
  METHODS
  Of 331 patients (225 male patients, 68%), mean age 49+/-10 years (range 14 to 69 years), 88% were in New York Heart Association functional class III or IV and 77% were in atrial fibrillation. Follow-up time extended more than 20 years (mean 13.9 years, range 0.3 to 24.7 years) for a total of 4,601 patient-years.
  
  
  RESULTS
  Overall operative mortality was 6.3%. At 5, 10, 15, and 20 years, the actuarial survival rate of patients were 71%+/-2%, 46%+/-3%, 30%+/-3%, and 22%+/-2%, respectively. Actuarial estimates of freedom from structural valve deterioration were 95%+/-1%, 67%+/-3%, 32%+/-3%, and 14%+/-3%; from reoperation were 96%+/-1%, 72%+/-3%, 36%+/-4%, and 18%+/-4%; from thromboembolism were 89%+/-2%, 82%+/-3%, 74%+/-4%, and 51%+/-2%; and from anticoagulant-related hemorrhage were 98%+/-1%, 96%+/-1%, 91%+/-1%, and 86%+/-4%. Estimates of freedom from all valve-related mortality at 5, 10, 15, and 20 years were 89%+/-2%, 76%+/-3%, 64%+/-4%, and 48%+/-4%. Multivariate analysis showed younger age to be a significant risk factor for reoperation. Age at operation did not correlate with structural valve deterioration.
  
  
  CONCLUSIONS
  The long-term results with the standard Hancock bioprosthesis implanted in the mitral position appear satisfactory, particularly up to 15 years from implantation. Protection from stroke, anticoagulant hemorrhage, and endocarditis was good.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Italy. fsant@yahoo.com
authors.forename: F
authors.initials: F
authors.lastname: Santini
authors.forename: G B
authors.initials: GB
authors.lastname: Luciani
authors.forename: S
authors.initials: S
authors.lastname: Restivo
authors.forename: G
authors.initials: G
authors.lastname: Casali
authors.forename: R
authors.initials: R
authors.lastname: Pessotto
authors.forename: P
authors.initials: P
authors.lastname: Bertolini
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.forename: A
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001705:Bioprosthesis; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate