Extended Follow-Up of the Standard Hancock Porcine Bioprosthesis

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Abstract
We have reviewed 665 patients in whom the standard Hancock porcine bioprosthesis (HPB) was used for aortic (AVR = 173), mitral (MVR = 437), and mitral and aortic (MAVR = 55) valve replacement in the time interval from 1970 to 1983. After AVR, HPB-related deaths occurred in 24 patients (1.7% ± 0.4% per patient-year); 11 had thromboembolic episodes (0.8% ± 0.2% per patient-year), 6 hemorrhages related to anticoagulants (0.4% ± 0.2% per patient-year), 9 endocarditis (0.7% ± 0.2% per patient-year), 7 prosthetic leak (0.5% ± 0.1 % per patient-year), and 59 structural deterioration (4.3% ± 0.6% per patient-year). At 16 years, actuarial survival is 40% ± 6%, freedom from thromboembolic episodes 89% ± 4%, from hemorrhages 90% ± 5%, from endocarditis 94% ± 2%, from prosthetic leak 95% ± 2%, and from structural deterioration 36% ± 6%. After MVR, HPB-related deaths occurred in 64 patients (1.6% ± 0.2% per patient-year); 68 had thromboembolic episodes (1.7% ± 0.2% per patient-year), 28 hemorrhages (0.7% ± 0.1% per patient-year), 12 endocarditis (0.3% ± 0.1% per patient-year), 9 prosthetic leak (0.2% ± 0.1% per patient-year), and 158 structural deterioration (4.0% ± 0.3% per patient-year). At 18 years, actuarial survival is 33% ± 4%, freedom from thromboembolic episodes 57% ± 13%, from hemorrhages 81% ± 6%, from endocarditis 91% ± 4%, from prosthetic leak 98% ± 1%, and from structural deterioration 18% ± 5%. After MAVR there were 18 HPB-related deaths (5.0% ± 1.3% per patient-year); 6 patients had thromboembolic episodes (1.7% ± 0.2% per patient-year), 6 hemorrhages (1.7% ± 0.2% per patient-year), 11 endocarditis (3.1% ± 1.1% per patient-year), 6 prosthetic leak (1.7% ± 0.7% per patient-year), and 17 structural deterioration (4.8% ± 1.2% per patient-year). At 14 years, actuarial survival is 26% ± 7%, freedom from thromboembolic episodes 85% ± 7%, from hemorrhages 80% ± 11%, from endocarditis 74% ± 7%, from prosthetic leak 93% ± 4%, and from structural deterioration 16% ± 10%. The HPB has shown excellent performance in the first decade that, however, becomes unacceptable thereafter due to the progressively increasing incidence of structural valve deterioration.