Hancock II 生物瓣置换主动脉瓣：生物瓣耐久性的金标准？
Hancock II bioprosthesis for aortic valve replacement: the gold standard of bioprosthetic valves durability?
机构信息
Division of Cardiovascular Surgery of Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
出版信息
Ann Thorac Surg. 2010 Sep;90(3):775-81. doi: 10.1016/j.athoracsur.2010.05.034.
BACKGROUND
This study examined the long-term durability of the Hancock II bioprosthesis (Medtronic, Minneapolis, MN) in the aortic position.
METHODS
From 1982 to 2004, 1134 patients underwent aortic valve replacement (AVR) with Hancock II bioprosthesis and were prospectively monitored. Mean patient age was 67 +/- 11 years; 202 patients were younger than 60, 402 were 60 to 70, and 526 were older than 70. Median follow-up was 12.2 years and 99.2% complete. Valve function was assessed in 94% of patients. Freedom from adverse events was estimated by the Kaplan-Meier method.
RESULTS
Survival at 20 and 25 years was 19.2% +/- 2% and 6.7% +/- 2.8%, respectively, with only 34 and 3 patients at risk. Survival at 20 years was 54.9% +/- 6.4% in patients younger than 60 years, 22.7% +/- 3.3% in those 60 to 70, and 2.4% +/- 1.9% in those older than 70 (p = 0.01). Structural valve deterioration developed in 67 patients aged younger than 60, in 18 patients aged 60 to 70, and in 2 patients older than 70. The freedom from structural valve deterioration at 20 years was 63.4% +/- 4.2% in the entire cohort, 29.2% +/- 5.7% in patients younger than 60 years, 85.2% +/- 3.7% in patients aged 60 to 70, and 99.8% +/- 0.2% in patients older than 70 (truncated at 18 years). Repeat AVR was performed in 104 patients (74 for structural valve failure, 16 for endocarditis, and 14 for other reasons). At 20 years, the overall freedom from AVR was 65.1% +/- 4% for any reason, 29.8% +/- 5.4% in patients younger than 60 years, 86.8% +/- 3.3% in patients 60 to 70, and 98.3% +/- 0.6% in patients older than 70.
CONCLUSIONS
Hancock II bioprosthesis is a very durable valve in patients 60 years and older and is probably the gold standard of bioprosthetic valve durability in this patient population.
背景
本研究旨在评估 Hancock II 生物瓣在主动脉瓣位置的长期耐久性。
方法
1982 年至 2004 年间，1134 例患者接受 Hancock II 生物瓣主动脉瓣置换术（美敦力，明尼苏达州明尼阿波利斯），并进行前瞻性监测。平均患者年龄为 67 ± 11 岁；202 例患者年龄小于 60 岁，402 例患者年龄为 60-70 岁，526 例患者年龄大于 70 岁。中位随访时间为 12.2 年，随访率为 99.2%。94%的患者评估了瓣膜功能。通过 Kaplan-Meier 方法估计不良事件无复发率。
结果
20 年和 25 年的生存率分别为 19.2%±2%和 6.7%±2.8%，仅有 34 例和 3 例患者处于风险中。60 岁以下患者的 20 年生存率为 54.9%±6.4%，60-70 岁患者为 22.7%±3.3%，70 岁以上患者为 2.4%±1.9%（p=0.01）。60 岁以下的 67 例患者、60-70 岁的 18 例患者和 70 岁以上的 2 例患者出现结构性瓣膜恶化。20 年时，整个队列的结构性瓣膜恶化无复发率为 63.4%±4.2%，60 岁以下患者为 29.2%±5.7%，60-70 岁患者为 85.2%±3.7%，70 岁以上患者为 99.8%±0.2%（18 岁时截断）。104 例患者（74 例因结构性瓣膜失效、16 例因感染性心内膜炎、14 例因其他原因）行再次主动脉瓣置换术。20 年时，任何原因的无再次主动脉瓣置换术生存率为 65.1%±4%，60 岁以下患者为 29.8%±5.4%，60-70 岁患者为 86.8%±3.3%，70 岁以上患者为 98.3%±0.6%。
结论
Hancock II 生物瓣在 60 岁及以上患者中是一种非常耐用的瓣膜，可能是该患者群体中生物瓣耐久性的金标准。
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