Abstract

Background. The 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). Methods. From 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 chi(2) 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. Results. The 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). Conclusions. Aortic 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. (Ann Thorac Surg 2011;92:541-7) (C) 2011 by The Society of Thoracic Surgeons ADULT CARDIAC