Aortic Valve Replacement With Hancock II Bioprothesis With and Without Replacement of the Ascending Aorta

摘要

Study Setting and Ethical RequirementsStudy Design and ParticipantsSurgical TechniqueCovariablesOutcomesStatistical AnalysisResultsFollow-UpCharacteristics of Propensity Score Matched SamplesSurvivalFreedom From Reoperation on Aortic Valve for Any ReasonFreedom From Structural Valve DeteriorationPerioperative Mortality and MorbidityCommentTheoretical Considerations and Clinical ImplicationsStudy LimitationsReferencesThe purpose of this study was to compare the clinical outcomes and valve durability after aortic valve replacement with a Hancock II bioprothesis with and without supracoronary replacement of the ascending aorta (RAA).MethodsFrom a cohort of 1,076 patients who had aortic valve replacement with a Hancock II bioprothesis who were prospectively followed for a median of 12.2 years, a propensity score analysis matched patients with and without RAA in a 1:4 ratio. Statistical analysis was performed using the χ2 test or Fisher's exact test for categorical variables, t tests or Wilcoxon rank sum test for continuous variables, and Kaplan-Meier estimates and log rank test for time-to-event data.ResultsThe propensity score analysis selected 89 patients with RAA and 356 without RAA whose mean age was 66 ± 12 years. Preoperative variables were similar in both groups, except that the ascending aorta was aneurysmal in patients who had RAA. Operative mortality was 2.3% and 3.9% in the RAA and non-RAA groups, respectively (p = 0.75). Perioperative morbidity was also similar. Only 3 and 13 patients lived beyond 20 years in the RAA and non-RAA groups, respectively. For the non-RAA group and RAA group, respectively, at 10, 15, and 20 years, respectively, the Kaplan-Meier estimates for freedom from death were 62.2% ± 2.8%, 36.5% ± 3.3%, 20.8% ± 3.6%, and 56.8% ± 6.1%, 31.8% ± 6.7%, 17.2% ± 6.6% (p = 0.51); for reoperation on the aortic valve for any reason, 95.3% ± 1.4%, 81.6% ± 3.9%, 70.5% ± 6.4%, and 91.7% ± 3.6, 85.7% ± 6.8%, 53.5% ± 18.8% (p = 0.51); and for structural valve degeneration, 98.5% ± 0.9%, 85.0% ± 3.8%, 66.8% ± 7.1%, and 94.4% ± 3.2%, 84.3% ± 7.5%, and 70.2% ± 14.3% (p = 0.38).ConclusionsAortic valve replacement with a Hancock II bioprothesis with or without RAA has similar clinical outcomes. Supracoronary RAA does not affect the rate of structural valve degeneration of this bioprosthesis.CTSNet classification:26, 35The clinical outcomes and valve durability after isolated aortic valve replacement (AVR) with the Hancock II bioprothesis (Medtronic, Minneapolis, MN) have been extensively studied in the past [