title: Aortic valve replacement with Hancock II bioprothesis with and without replacement of the ascending aorta.
abstract: BACKGROUND
  The purpose of this study was to compare the clinical outcomes and valve durability after aortic valve replacement with a Hancock II bioprothesis with and without supracoronary replacement of the ascending aorta (RAA).
  
  
  METHODS
  From a cohort of 1,076 patients who had aortic valve replacement with a Hancock II bioprothesis who were prospectively followed for a median of 12.2 years, a propensity score analysis matched patients with and without RAA in a 1:4 ratio. Statistical analysis was performed using the χ2 test or Fisher's exact test for categorical variables, t tests or Wilcoxon rank sum test for continuous variables, and Kaplan-Meier estimates and log rank test for time-to-event data.
  
  
  RESULTS
  The propensity score analysis selected 89 patients with RAA and 356 without RAA whose mean age was 66±12 years. Preoperative variables were similar in both groups, except that the ascending aorta was aneurysmal in patients who had RAA. Operative mortality was 2.3% and 3.9% in the RAA and non-RAA groups, respectively (p=0.75). Perioperative morbidity was also similar. Only 3 and 13 patients lived beyond 20 years in the RAA and non-RAA groups, respectively. For the non-RAA group and RAA group, respectively, at 10, 15, and 20 years, respectively, the Kaplan-Meier estimates for freedom from death were 62.2%±2.8%, 36.5%±3.3%, 20.8%±3.6%, and 56.8%±6.1%, 31.8%±6.7%, 17.2%±6.6% (p=0.51); for reoperation on the aortic valve for any reason, 95.3%±1.4%, 81.6%±3.9%, 70.5%±6.4%, and 91.7%±3.6, 85.7%±6.8%, 53.5%±18.8% (p=0.51); and for structural valve degeneration, 98.5%±0.9%, 85.0%±3.8%, 66.8%±7.1%, and 94.4%±3.2%, 84.3%±7.5%, and 70.2%±14.3% (p=0.38).
  
  
  CONCLUSIONS
  Aortic valve replacement with a Hancock II bioprothesis with or without RAA has similar clinical outcomes. Supracoronary RAA does not affect the rate of structural valve degeneration of this bioprosthesis.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Garrido-Olivares
authors.forename: Manjula
authors.initials: M
authors.lastname: Maganti
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: Tirone
authors.initials: T
authors.lastname: David
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data