Borger Michael A, Ivanov Joan, Armstrong Susan, Christie-Hrybinsky Debbie, Feindel Christopher M, David Tirone E
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Heart Valve Dis. 2006 Jan;15(1):49-55; discussion 55-6.
The Hancock II bioprosthesis (HII) has several design features designed to increase its durability. The study aim was to determine very long-term outcomes for the HII valve in a large patient population.
Long-term follow up was obtained by mail and/or telephone questionnaire of patients undergoing HII valve replacement surgery between 1982 and 2001 (n = 1,569). Follow up was complete on 1,568 patients (99.9%), and ranged from 0 to 250 months.
Isolated aortic valve replacement (AVR) was performed in 1,010 patients and mitral valve replacement (MVR) in 559. The average (+/- SD) age of patients was 67 +/- 11 years, and 65% were males. Long-term death occurred in 445 AVR patients and 275 MVR patients, of which 11% and 17%, respectively, were valve-related. Twenty-year freedom from thromboembolism (all results actuarial) was 79 +/- 3% after AVR and 83 +/- 3% after MVR; freedom from endocarditis was 91 +/- 5% and 85 +/- 5%, respectively. Twenty-year freedom from structural valve deterioration (SVD) was 73 +/- 16% and 39 +/- 9% in AVR patients aged > or = 65 years and < 65 years, respectively. Similarly, 20-year freedom from SVD was 59 +/- 11% and 27 +/- 9% in MVR patients aged > or = 65 years and < 65 years, respectively. When actual statistical techniques were applied (cumulative incidence), 20-year actual risk of SVD was 18 +/- 3% in all AVR patients and 23 +/- 3% in all MVR patients. Reoperation was required in 72 AVR patients, and was valve-related in 60. A total of 49 MVR patients underwent reoperation; 48 of these were valve-related.
The Hancock II bioprosthesis continues to show very good long-term results and durability, particularly in patients aged over 65 years.
汉考克二代生物瓣膜（HII）具有多项旨在提高其耐用性的设计特点。本研究的目的是确定在大量患者群体中HII瓣膜的极长期疗效。
通过对1982年至2001年间接受HII瓣膜置换手术的患者（n = 1569）进行邮件和/或电话问卷调查来获得长期随访结果。对1568例患者（99.9%）完成了随访，随访时间为0至250个月。
1010例患者接受了单纯主动脉瓣置换术（AVR），559例患者接受了二尖瓣置换术（MVR）。患者的平均（±标准差）年龄为67±11岁，65%为男性。445例AVR患者和275例MVR患者发生了长期死亡，其中分别有11%和17%与瓣膜相关。AVR术后20年无血栓栓塞事件（所有结果均为精算值）的发生率为79±3%，MVR术后为83±3%；无感染性心内膜炎的发生率分别为91±5%和85±5%。年龄≥65岁和＜65岁的AVR患者20年无结构性瓣膜退变（SVD）的发生率分别为73±16%和39±9%。同样，年龄≥65岁和＜65岁的MVR患者20年无SVD的发生率分别为59±11%和27±9%。当应用实际统计技术（累积发病率）时，所有AVR患者20年SVD的实际风险为18±3%，所有MVR患者为23±3%。72例AVR患者需要再次手术，其中60例与瓣膜相关。共有49例MVR患者接受了再次手术；其中48例与瓣膜相关。
汉考克二代生物瓣膜继续显示出非常好的长期疗效和耐用性，尤其是在65岁以上的患者中。
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