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.