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Ann Thorac Surg 1991;51:430-437
© 1991 The Society of Thoracic Surgeons

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Articles

Failure of Hancock pericardial xenografts: Is prophylactic bioprosthetic replacement justified?

Departments of Cardiovascular Surgery and Pathology, University of Padova Medical School, Padova, Italy

Accepted for publication November 2, 1990.

^_* Address reprint requests to Dr Bortolotti, Istituto di Chirurgia Cardiovascolare, Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy.

The incidence of major valve-related complications was evaluated in a series of patients in whom the Hancock pericardial xenograft was used for aortic (AVR; n = 84), mitral (MVR; n = 17) and mitral-aortic (MAVR; n = 13) valve replacement. At 7 years actuarial survival is 66% ± 8% after AYR, 64% ± 13% after MVR, and 41% ± 15% after MAVR, whereas actuarial freedom from valve-related death is 79% ± 7% after AVR, 78% ± 13% after MVR, and 81% ± 12% after MAVR. Actuarial freedom from thromboemboli and anticoagulant-related hemorrhage at 7 years is 93% ± 4% and 98% ± 2% after AVR and 83% ± 10% and 88% ± 11% after MVR; no such complications occurred after MAVR. Structural valve deterioration determined at reoperation, at autopsy, or by clinical investigation was observed in 34 patients with AVR (10.0 ± 0.2%/patient-year), in 10 with MVR (10.6 ± 3.3% /patient-year), and in 9 with MAVR (16.6 ± 5.5%/ patient-year). After AVR, 19 patients underwent reoperation and 2 died before reoperation; 4 patients with MVR underwent reoperation, and 7 patients with MAVR underwent reoperation and 1 died before reoperation. Seventy-eight percent of the current survivors (13 patients with AVR, 7 with MVR, and 1 with MAVR) have clinical evidence of valve failure. At 7 years actuarial freedom from structural deterioration of the Hancock pericardial xenograft is 25% ± 7% after AVR, 29% ± 14% after MVR, and 0% after MAVR. The extremely poor durability of the Hancock pericardial xenograft, besides confirming the need for a closer noninvasive monitoring of Hancock pericardial xenograft recipients, justifies prophylactic replacement of this device in asymptomatic patients with clinical evidence of Hancock pericardial xenograft dys-function.

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