Late complications of heart valve replacement.

Abstract

Valve replacement by prosthetic device or graft has become an accepted method of surgical approach in the treatment of valvular heart disease dur­ ing the past decade. Reasonable operative risks have been achieved by im­ provement in surgical technics and heart-lung bypass procedures. Control o'f infection, heart block, coagulation problems, and the recognition of the vari­ ous postperfusion syndromes have helped reduce early postoperative mortal­ ity. The effect of valve replacement on the natural course of heart disease is dependent upon the status of the pre-existing myocardial reserve, the de­ gree of hemodynamic improvement accomplished, and the reversibility of functional disability. The etiology of the underlying heart disease-inflam­ matory, congenital, infectious, or degenerative-pla ys a part. Long-term re­ sults are further influenced by complications directly related to the pros­ thetic device. Poor mechanical performance and durability has caused the abandon­ ment of flexible leaflet artificial prostheses. Most surgeons now use a vari­ ety of rigid artificial valves either of the caged-baH or low profile-disc type. Others are substitutin g homologous or heterologous valve grafts for the dis­ eased tissue. The late complications of these procedures will be considered separately.