Twenty-year follow-up of the Hancock modified orifice porcine aortic valve

Background. The entire experience with the Hancock modified orifice porcine bioprosthetic aortic valve from 1976 to 1996 at the Brigham and Women's Ho spital has been reviewed. Eight hundred forty-three patients received this valve with a total follow-up of 61,114 months, and a mean follow-up of appr oximately 72.5 months. There were 490 men and 353 women, and the predominat e lesion was aortic stenosis (636 of 843); 365 (43%) patients required a co ncomitant coronary artery bypass graft operation. Methods. patients were followed prospectively in the Brigham Cardiac Valve Data Registry, and the data were analyzed by the SAS statistical package, u sing actuarial survival curves and incidence per patient-year of morbidity and mortality. Results. The overall operative mortality was 45 of 843 (5.3%) with 23 of 47 8 (4.8%) for isolated aortic valve replacement and 22 of 365 (6.0%) for aor tic valve plus coronary artery bypass graft operation. The major morbidity of this valve was structural valve dysfunction, which was significantly rel ated to the age of the patient in whom the valve was placed. Actuarial prob ability of freedom from structural valve degeneration at 5, 10, and 15 year s overall was 99% +/- 1%, 79% +/- 3% and 57% +/- 4%, at 15 years, respectiv ely. In patients younger than 50 years, freedom from structural valve dysfu nction was 16% +/- 8%, whereas in the age group older than 70 years it was 87% +/- 5% (p = 0.0005). Thromboembolism at 10 and 15 years was 81% +/- 3% overall, 84% +/- 2% in patients in normal sinus rhythm, and 57% +/- 13% in patients with chronic atrial fibrillation. Conclusions. The Hancock modified orifice aortic valve, despite its more co mplicated fabrication, has been a reliable porcine bioprosthetic valve and can be used reliably in patients older than 70 years because of its low str uctural valve degeneration rate, and protection from stroke and anticoagula nt hemorrhage in those patients in sinus rhythm. (C) 1998 by The Society of Thoracic Surgeons.