ウネ　ダイ   Dai Une   畝　大    所属   川崎医科大学  医学部 臨床医学　心臓血管外科学    職種   教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Twenty-year durability of the aortic Hancock II bioprosthesis in young patients: is it durable enough?
掲載誌名	正式名：European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 略　 称：Eur J Cardiothorac Surg ISSNコード：1873734X/10107940
掲載区分	国外
巻・号・頁	46(5),pp.825-30
著者・共著者	Dai Une, Marc Ruel, Tirone E David
発行年月	2014/11
概要	OBJECTIVES:There is a current trend towards the use of bioprosthetic aortic valves in the aortic position in young patients, but there is limited information on durability beyond the first decade. The Hancock II bioprosthesis has been reported to have excellent durability in patients ≥ 60 years of age. This study examines the long-term durability of the Hancock II bioprosthesis in the aortic position in patients <60 years of age.METHODS:From 1982 to 2008, 304 patients aged 59 years or less underwent aortic valve replacement (AVR) with a Hancock II bioprosthesis at two centres. The mean age was 49.2 ± 9.0 years, and 79% of the patients were male. Valve function was serially assessed by echocardiography. The median follow-up was 14.6 years (maximum 27.5 years). Survival and freedom from adverse events were calculated by using a Kaplan-Meier method. Independent predictors of those events were assessed by using Cox proportional hazards analyses.RESULTS:Survival and freedom from repeat AVR (re-AVR) at 20 years were 57.0 ± 6.1 and 25.4 ± 4.7%, respectively. During the follow-up, 100 patients (33%) underwent re-AVR: 78 for structural valve deterioration (SVD), 11 for endocarditis, 4 for non-structural valve dysfunction and 7 for other reasons. The overall 10-, 15- and 20-year freedom from re-AVR due to SVD were 91.4 ± 2.1, 64.7 ± 4.3 and 29.1 ± 5.3%, respectively. By age group, the 20-year freedom from re-AVR due to SVD amounted to 14.1 ± 8.7% in patients younger than 40 years of age, 21.5 ± 8.5% in patients aged 40-49 and 41.4 ± 8.2% in patients between 50 and 59 (P = 0.04). The independent predictors of re-AVR due to SVD were age [odds ratio (OR): 0.72 per 10 years; 95% confidence interval (CI): 0.58, 0.90; P < 0.01] and prosthesis-patient mismatch (PPM) (effective orifice area index <0.80 cm(2)/m(2)) (OR: 1.63; 95% CI: 1.01, 2.63; P = 0.045).CONCLUSIONS:The Hancock II bioprosthesis for AVR in patients <60 years of age is associated with excellent durability during the f
DOI	10.1093/ejcts/ezu014
PMID	24510909