Abstract 3687: Long-term Clinical and Hemodynamic Performance of the Medtronic Hancock II versus the Carpentier-Edwards Perimount Aortic Bioprostheses
Introduction: The Medtronic Hancock II and the Carpentier-Edwards Perimount are the world’s most commonly used aortic bioprostheses. However, a direct comparison of their clinical performance has never been made available.
Hypothesis: To minimize observation and selection biases inherent to between-studies comparisons, we examined these prostheses in a large, contemporary, single-center cohort where equivalent operative and postoperative management were used.
Methods: Between 1990 and 2007, 1656 patients (mean age 73.1±9.3 years) underwent first-time aortic valve replacement with the Hancock II (N=1019) or the Perimount (N=637). Surgeons used either of the two prostheses according to availability, professional opinion, and patient preferences. Patients were prospectively followed with serial clinic visits and echocardiograms for up to 16 years (mean 4.0±3.5 years).
Results: There was no difference in preoperative aortic root size (P=NS). Aortic root enlargement was more commonly performed with the Perimount (P<0.001), but the manufacturer valve size of the implanted prosthesis was larger with the Hancock II (23.5±1.7 for Hancock II versus 22.7±1.9 for Perimount). In the late postoperative phase (mean 3.3±0.1 years postoperatively), in vivo EOA was larger, and peak and mean transprosthetic gradients were lower for the Perimount (24.9±0.7 and 13.4±0.4 mmHg, respectively) than for the Hancock II (32.7±0.7 and 16.0±0.3 mmHg)(P<0.001). Five- and 10-year actuarial survival was 84.2±1.6% and 60.6±3.2% for Hancock II, and 85.2±2.1% and 68.3±4.4% for Perimount, respectively (P=NS). Multivariate predictors of late survival included age at operation, and concomitant CABG (Both P<0.05), but not prosthesis type (P=NS). Ten-year freedom from structural valve deterioration was 93.7±2.4% for Hancock II versus 97.1±1.8% for Perimount (P=NS).
Conclusion: For the same manufacturer valve size, the Perimount is larger, which may warrant enlarging the aortic root more often, and is associated with better hemodynamics than the Hancock II. Nevertheless, with minimization of bias and patient confounders, the long-term clinical performances of the Hancock II and Perimount bioprostheses are equivalent.