Fifteen-year experience with 1678 Hancock porcine bioprosthetic heart valve replacements.

The Hancock porcine valve was the first commercially available biologic heart valve and has been in continuous use at the Brigham and Women's Hospital since January 1972. Through December 1987 we implanted 1678 valves in 1533 patients (885 male; 648 female; 17 to 95 years of age, with a mean of 60 years). There were 825 aortic valve replacements (AVR), 562 isolated mitral valve replacements (MVR), and 146 aortic mitral replacements (DVR). Ninety-four per cent of the patients were functional class III or IV. Associated coronary bypass was done in 25% of patients. Four per cent of patients were lost to follow up during a 1- to 16-year period with a mean of 6 years. Morbidity and mortality rates on a actuarial basis were calculated 10 and 15 years after operation for AVR, MVR, and DVR. The data indicates that the probability of reoperation for structural valve failure is quite reasonable as of 10 years, but from 10 to 15 years the numbers sharply fall off so that the probable effective life of the valve is 10 years. However in the elderly age group (equal to or greater than 70 years of age) the incidence of structural valve degeneration is markedly diminished, making this an ideal valve substitute for the elderly. It is also an ideal valve substitute in any patient who has a contraindication to long-term anticoagulation because of current medical or surgical problems.