Twenty-year results of the Hancock II bioprosthesis.
OBJECTIVE
The Hancock II bioprosthesis (HII) has several design features designed to increase its durability. The study aim was to determine very long-term outcomes for the HII valve in a large patient population.


METHODS
Long-term follow up was obtained by mail and/or telephone questionnaire of patients undergoing HII valve replacement surgery between 1982 and 2001 (n = 1,569). Follow up was complete on 1,568 patients (99.9%), and ranged from 0 to 250 months.


RESULTS
Isolated aortic valve replacement (AVR) was performed in 1,010 patients and mitral valve replacement (MVR) in 559. The average (+/- SD) age of patients was 67 +/- 11 years, and 65% were males. Long-term death occurred in 445 AVR patients and 275 MVR patients, of which 11% and 17%, respectively, were valve-related. Twenty-year freedom from thromboembolism (all results actuarial) was 79 +/- 3% after AVR and 83 +/- 3% after MVR; freedom from endocarditis was 91 +/- 5% and 85 +/- 5%, respectively. Twenty-year freedom from structural valve deterioration (SVD) was 73 +/- 16% and 39 +/- 9% in AVR patients aged > or = 65 years and < 65 years, respectively. Similarly, 20-year freedom from SVD was 59 +/- 11% and 27 +/- 9% in MVR patients aged > or = 65 years and < 65 years, respectively. When actual statistical techniques were applied (cumulative incidence), 20-year actual risk of SVD was 18 +/- 3% in all AVR patients and 23 +/- 3% in all MVR patients. Reoperation was required in 72 AVR patients, and was valve-related in 60. A total of 49 MVR patients underwent reoperation; 48 of these were valve-related.


CONCLUSIONS
The Hancock II bioprosthesis continues to show very good long-term results and durability, particularly in patients aged over 65 years.
Borger
Michael A
MA
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. michael.borger@uhn.on.ca
Ivanov
Joan
J
Armstrong
Susan
S
Christie-Hrybinsky
Debbie
D
Feindel
Christopher M
CM
David
Tirone E
TE
D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome