Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Circulation. 2010 Sep 14;122(11 Suppl):S10-6. doi: 10.1161/CIRCULATIONAHA.109.928085.
The Medtronic Hancock II and the Carpentier-Edwards Perimount are among the world's most commonly used aortic bioprostheses. However, a direct comparison of their clinical performance is lacking. To minimize biases inherent to between-center comparisons, we examined these prostheses within a large, contemporary, single-center cohort.
Between 1990 and 2007, 1659 patients (mean age, 73.1±9.3 years) underwent aortic valve replacement with either the Hancock II (N=1021) or the Perimount (N=638). Patients were prospectively followed-up with serial clinic visits and echocardiograms for up to 16 years (mean, 5.0±3.3 years). There was no significant difference in aortic root size preoperatively (P=0.7). Aortic root enlargement was more commonly performed with the Perimount (P<0.001), and the manufacturer valve size of the implanted prosthesis was larger with the Hancock II (P<0.001). Postoperatively, peak and mean transprosthesis gradients were higher for the Hancock II (32.7±0.7 and 16.0±0.3 mm Hg, respectively) than for the Perimount (24.9±0.7 and 13.4±0.4 mm Hg, respectively; P<0.001). However, no difference in left ventricular mass regression was observed at late follow-up (P=0.9). Unadjusted 10-year survival was 59.4%±2.4% for the Hancock II and 70.2%±3.8% for the Perimount (P=0.07). Multivariable predictors of survival did not include prosthesis type (P=0.2).
For the same manufacturer valve size, the Perimount is larger, which may warrant enlarging the aortic root more often, and it is associated with better hemodynamics than the Hancock II. These differences do not impact survival or left ventricular mass regression, and the long-term clinical performances of the Hancock II and Perimount bioprostheses are equivalent.
美敦力 Hancock II 和爱德华兹 Carpentier-Edwards Perimount 是世界上使用最广泛的两种主动脉生物瓣。然而，缺乏对它们临床性能的直接比较。为了将中心间比较固有的偏倚降到最低，我们在一个大型的、当代的、单中心队列中检查了这些假体。
1990 年至 2007 年间，1659 例患者（平均年龄 73.1±9.3 岁）接受了主动脉瓣置换术，其中 Hancock II 组 1021 例，Perimount 组 638 例。前瞻性随访时间为 16 年（平均 5.0±3.3 年），随访内容包括定期门诊就诊和超声心动图检查。术前主动脉根部大小无显著差异（P=0.7）。Perimount 组更常进行主动脉根部扩张（P<0.001），且 Hancock II 组植入的假体制造商尺寸更大（P<0.001）。术后，Hancock II 组的跨瓣峰值和平均压差分别为 32.7±0.7 和 16.0±0.3mmHg，高于 Perimount 组的 24.9±0.7 和 13.4±0.4mmHg（P<0.001）。然而，在晚期随访时未观察到左心室质量回归的差异（P=0.9）。未调整的 10 年生存率 Hancock II 组为 59.4%±2.4%，Perimount 组为 70.2%±3.8%（P=0.07）。生存的多变量预测因素不包括假体类型（P=0.2）。
对于相同制造商的瓣膜尺寸，Perimount 更大，这可能需要更频繁地扩大主动脉根部，并且与 Hancock II 相比具有更好的血液动力学性能。这些差异不会影响生存或左心室质量回归，并且 Hancock II 和 Perimount 生物瓣的长期临床性能相当。
