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.
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
Michael A
MA
Borger
Joan
J
Ivanov
Susan
S
Armstrong
Debbie
D
Christie-Hrybinsky
Christopher M
CM
Feindel
Tirone E
TE
David
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