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Ann Thorac Surg 1984;38:571-578
© 1984 The Society of Thoracic Surgeons
Departments of Cardiovascular Surgery and Pathology, University of Padova Medical School, Padova, Italy
* Address reprint requests to Dr. Gallucci, Centro di Chirurgia Cardiovascolare, Universitá di Padova, Via Giustiniani, 2, 35100 Padova, Italy
Four hundred seventy-six patients underwent isolated mitral valve replacement (MVR) with the glutaraldehyde-preserved porcine Hancock bioprosthesis from March, 1970, through December, 1981. There were 312 female and 164 male patients ranging in age at operation from 9 to 68 years (average, 53 years). Associated surgical procedures were performed in 35 patients. Hospital mortality was 13%, the main cause of death being low-output syndrome.
The survivors were followed from 1.6 to 13.2 years (mean, 5.2 years). Cumulative duration of follow-up is 2,180 patient-years and is 97% complete. Overall late mortality is 3.1 ± 0.3% per patient-year, and actuarial survival is 73.8 ± 3.4% at 13 years. Embolic accidents occurred in 45 patients and were fatal in 13; the linearized incidence of postoperative systemic thromboemboli is 2.1 ± 0.3% per patient-year. Reoperation was necessary in 49 patients: in 4 because of valve endocarditis, with 3 deaths; in 6 because of perivalvular leak, with no deaths; in 2 because of left atrial thrombosis; and in 37 because of valve dysfunction due to primary tissue failure, caused mainly by calcific degeneration of the tissue, with 5 operative deaths. Actuarial freedom from primary tissue failure is 58 ± 6.6% at 13 years.
Extended follow-up after MVR with the Hancock bioprosthesis confirms the satisfactory performance and low thrombogenicity of this device up to 13 years after operation. Calcific degeneration of the cusps remains the chief cause of valve failure leading to reoperation and may represent a major problem. Therefore, until further data on the prevention of the calcific process are available from ongoing experimental studies, we will use the Hancock bioprosthesis for MVR in patients selected according to age and specific situations.
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