Pathologic anatomy of cardiac valve replacement: A study of 224 necropsy patients

Abstract

Necropsy observations are described in 224 patients who died from 1963 through October 1972 after replacement of one or more cardiac valves by prostheses: 128 patients died within 2 mo of operation, and 96 patients at later periods up to 116 mo. Of the 281 valves replaced, Starr-Edwards prostheses were used in 250. Prosthetic dysfunction continues to be the most common cause of death (approximately 30%) in patients dying either early or late after valve replacement. It is hoped that the metal balls and cloth-covered struts will decrease the late frequency of prosthetic dysfunction, but not enough time has elapsed for this altered prosthesis to be tested adequately. Present data indicate that the frequency of clinical embolism and prosthetic thrombosis after use of the clothcovered prostheses is less than that observed in the noncloth-covered prostheses. Cloth wear with possible dislodgement and increased intravascular hemolysis, however, remains of concern. The frequencies of peribasilar fistulae, infection at sites of attachment of prostheses, and aneurysm formation at sites of excision of left ventricular papillary muscles are decreasing. It appears that secondary left ventricular endocardial fibroelastosis after mitral replacement, aortic root and coronary ostial intimal proliferation after aortic valve replacement and calcification of valve anuli will only increase with time after valve replacement. The latter changes may prove to be major long-term problems. It is clear after a decade of cardiac valve replacement that the ideal valve prosthesis is not yet available, or if available, not adequately tested. Thus, valve replacement at this time must be reserved for the patient severely disabled by cardiac valve disease.