Echocardiographic and pathologic features at explanted Hancock and Carpentier-Edwards bioprosthetic values in the mitral position

Modes of failure of Hancock and Carpentier-Edwards (C-E) porcine bioprosthe tic valves placed in the mitral position are not completely understood. We reviewed transesophageal echocardiographic (n = 19) and pathologic features of failed Hancock (n = 22) and C-E (n = 8) porcine mitral valves in 30 pat ients (mean age 70 +/- 13 years). Age at implantation (59 +/- 14 vs 58 +/- 14 years, p = 0.9), time to implanted valve degeneration (13 +/- 5 vs 11 +/ - 2 years, p = 0.3), and size of bioprosthesis (30 +/- 2 vs 31 +/- 2 mm, p = 0.14) of the implanted Hancock and C-E valves were similar. Anterior leaf let was flair in 15 versus flail posterior leaflet in 5 patients (p = 0.000 4). Eccentric posterior mitral regurgitation jet was present in 12, eccentr ic anterior jet in 2, central jet in 2, and paravalvular jet in 3 patients. Stenosis of bioprosthesis was present in 11 Hancock versus 1 C-E valve (p = 0.06). Stent creep at any stent post was present in 14 Hancock versus no C-E valve (p = 0.0013). Large commissural dehiscence was present in 5 C-E v ersus 1 Hancock valve (p = 0.0006). Ring margin perforation was the most co mmon perforation in Hancock valves (p <0.05, analysis of variance versus al l at her Hancock perforations). Dehiscence at the stent posts was the most common perforation in C-E valves (p <0.05 vs other C-E perforations, analys is of variance and p <0.001 versus Hancock valves). Thus, Hancock valves sh owed greeter stenosis and stent creep, whereas C-E valves showed large dehi scences at the stent posts on explantation. The anterior leaflet degenerate d most frequently in both valves. These findings suggest that the valve des ign may influence the mechanisms of porcine valve degeneration. (C) 1999 by Excerpta Medico, Inc.