Legarra J J, Llorens R, Catalan M, Segura I, Trenor A M, de Buruaga J S, Rabago G, Sarralde A
Division of Cardiovascular Surgery, University Clinic, University of Navarra, Pamplona, Spain.
J Heart Valve Dis. 1999 Jan;8(1):16-24.
The long-term (18 years) results after aortic (AVR), mitral (MVR) and double (aortic/mitral, DVR) valve replacement with Hancock II bioprosthesis were investigated.
Between 1978 and 1996, 279 Hancock II bioprostheses were implanted in 269 patients (166 males, 113 females; mean age 61.8+/-13.3 years). There were 135 AVR (48.4%), 122 MVR (43.8%) and 22 DVR (7.8%). Preoperatively, 208 patients (77.3%) were in NYHA functional class III/IV, 53 (19.7%) had previous cardiac surgery, and 19 (7.1%) underwent concomitant coronary artery bypass. Follow up (mean seven years) was 96% complete, with a total of 1,857 patient-years.
There were 20 early (7.3%), and 78 (29.0%) late deaths. At the last follow up, 68.3% of patients were in NYHA functional class I/II. The actuarial survival rate of patients at 10 and 18 years after discharge was 67.7+/-5.0% and 44.7+/-8.8% after AVR and 64.5+/-5.6% and 32.7+/-11.5% after MVR, respectively; survival after DVR was 74.0+/-11.2% at 12 years. At 10 and 18 years, actuarial freedom from thromboembolism was 83.5+/-4.5% and 73.1+/-10.5% after AVR and 82.1+/-4.3% and 73.2+/-7.3% after MVR; it was 78.4+/-15.0% after DVR at 12 years. At these times, actuarial freedom from hemorrhage was 88.7+/-3.8% and 83.5+/-6.2% after AVR and 79.0+/-4.9% and 32.6+/-23.3% after MVR; freedom after DVR was 36.2+/-26.6%. Probability of freedom from endocarditis at 10 and >15 years was 93.4+/-3.5% and 85.9+/-7.8% after AVR and 97.0+/-2.1% and 97.0+/-2.1% for MVR, respectively; freedom at 10 years after DVR was 75.0+/-21.6%. Freedom from structural deterioration at 10 and 18 years was 77.9+/-5.3% and 18.7+/-14.6% after AVR and 78.3+/-6.0% and 32.1+/-10.2% after MVR; freedom at 10 and 12 years after DVR was 64.0+/-17.5% and 32.0+/-24.2%. A low incidence of structural valve deterioration was found in AVR patients aged >65 years (p = 0.0478). Hemorrhage and paravalvular leak were more frequent in MVR (p = 0.0296 and 0.0309, respectively). No difference was seen in thromboembolism after anticoagulation for one or three months after AVR. Actuarial freedom from explantation at 10 and 18 years was 73.1+/-5.9% and 15.9+/-13.5% after AVR and 77.1+/-6.1% and 37.3+/-9.7% after MVR; freedom at 10 and 12 years after DVR was 72.0+/-17.8% and 24.0+/-20.4%.
Over an 18-year follow up, the Hancock II bioprosthesis has shown satisfactory results, with a low incidence of valve-related complications, especially in elderly patients in the aortic position.
研究了使用汉考克II型生物瓣膜进行主动脉瓣置换术（AVR）、二尖瓣置换术（MVR）和双瓣置换术（主动脉瓣/二尖瓣，DVR）后的长期（18年）结果。
1978年至1996年间，269例患者（166例男性，113例女性；平均年龄61.8±13.3岁）植入了279个汉考克II型生物瓣膜。其中135例为AVR（48.4%），122例为MVR（43.8%），22例为DVR（7.8%）。术前，208例患者（77.3%）处于纽约心脏协会（NYHA）功能分级III/IV级，53例（19.7%）曾接受过心脏手术，19例（7.1%）同时接受了冠状动脉搭桥术。随访（平均7年）完成率为96%，总计1857患者年。
有20例早期死亡（7.3%），78例晚期死亡（29.0%）。在最后一次随访时，68.3%的患者处于NYHA功能分级I/II级。AVR术后出院10年和18年患者的精算生存率分别为67.7±5.0%和44.7±8.8%，MVR术后分别为64.5±5.6%和32.7±11.5%；DVR术后12年生存率为74.0±11.2%。AVR术后10年和18年无血栓栓塞的精算自由度分别为83.5±4.5%和73.1±10.5%，MVR术后分别为82.1±4.3%和73.2±7.3%；DVR术后12年为78.4±15.0%。此时，AVR术后无出血的精算自由度分别为88.7±3.8%和83.5±6.2%，MVR术后分别为79.0±4.9%和32.6±23.3%；DVR术后为36.2±26.6%。AVR术后10年和>15年无感染性心内膜炎的概率分别为93.4±3.5%和85.9±7.8%，MVR分别为97.0±2.1%和97.0±2.1%；DVR术后10年为75.0±21.6%。AVR术后10年和18年无结构恶化的自由度分别为77.9±5.3%和18.7±14.6%，MVR术后分别为78.3±6.0%和32.1±10.2%；DVR术后10年和12年为64.0±17.5%和32.0±24.2%。在年龄>65岁的AVR患者中发现结构瓣膜恶化的发生率较低（p = 0.0478）。MVR术后出血和瓣周漏更常见（分别为p = 0.0296和0.0309）。AVR术后抗凝1个月或3个月后血栓栓塞情况无差异。AVR术后10年和18年无瓣膜取出的精算自由度分别为73.1±5.9%和15.9±13.5%，MVR术后分别为77.1±6.1%和37.3±9.7%；DVR术后10年和12年为72.0±17.8%和24.0±20.4%。
经过18年的随访，汉考克II型生物瓣膜显示出令人满意的结果，瓣膜相关并发症发生率低，尤其是在主动脉位置的老年患者中。
