The Standard Hancock Porcine Bioprosthesis: Overall Experience at the University of Padova

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Abstract
All patients undergoing aortic (AVR, n = 196), mitral (MVR, n = 502), and mitralaortic (MAVR, n = 71) valve replacement with a standard Hancock porcine bioprosthesis (HPB) from 1970 to 1983 were reviewed. A total of 665 patients discharged were followed for 5,099 patient-years with an actuarial survival at 15 years of 52% ± 4.5%, for MVR, 37% ± 14% for AVR, and at 12 years of 52 ± 7.4% for MAVR. Embolic episodes occurred in 9 patients after AVR (0.7% ± 0.2% pt-yr), in 61 after MVR (1.7% ± 0.2% pt-yr), and in 6 after MAVR (1.7% ± 0.7% pt-yr); actuarial freedom from emboli at 15 years is 91% ± 3.5% after AVR, 79% ± 14% after MVR, and at 12 years is 87% ± 5% after MAVR. Reoperation because of primary tissue failure (PTF) was performed in 47 patients with AVR (3.9% ± 0.5% pt-yr), 91 with MVR (2.6% ± 0.3% pt-yr), and in 13 with MAVR (4.1% ± 1.1% pt-yr); actuarial freedom from PTF at 15 years is 41% ± 5.5% after MVR, 37% ± 10% after AVR, and at 12 years is 49% ± 13% after MAVR. After AVR and MVR, freedom from PTF is significantly better for patients over 50 years of age. HPB-related complications occurred in 80 patients with AVR (6.3% ± 0.7% pt-yr), 195 with MVR (5.5 ± 0.4 pt-yr), and in 41 with MAVR (12.0% ± 1.8% pt-yr); actuarial freedom all HPB-related complications at 15 years is 25% ± 4% after MTR, 23% ± 7.5% after ATR, and at 12 years is 20 ± 8.5% after MAVR. This extended follow-up of HPB recipients shows that the performance of this device declines progressively after the eighth postoperative year, becoming unsatisfactory beyond this limit mainly because of the increasing impact of PTF on HPB durability. These results justify our current trend to restrict HPB to a selected patient population.