Replacement of prosthetic heart valves: A fifteen-year experience

Abstract

During a 15 year period from January, 1962, through March, 1977, 74 patients have had operations for problems of periprosthetic leak, infection, wear, or thrombosis of a prosthetic heart valve. Fifty-eight patients had replacement of the prosthesis, three of whom had had a previous attempt at repair of a periprosthetic leak. Analysis revealed that the frequency of reoperation has increased of late because of valve wear, whereas the frequency of reoperation for surgically related periprosthetic leak and endocarditis has decreased. Fifty-four percent of patients appeared within the first year after valve replacement. Leak was most often associated with a mitral prosthesis. Worn prostheses most often removed in this study were the Beall (16) and the Starr-Edwards aortic 2300 series (four). Thrombosis of a prosthetic valve was seen least frequently (eight valves). Three of the seven patients had no effective anticoagulation. The surgically related mortality rate (early and late) was 42 percent, which did not change statistically with regard to time, number of cases per year, or with the introduction of adjunctive myocardial preservation and support measures. The mortality rate was related to diagnosis but not to valve position. The relationships between surgery, patient, and valve as a cause for the complications were equally divided. This experience demonstrates the need for prevention of complication(s) in contrast to palliative or secondary curative procedures. It is recommended that strict attention be paid to exacting aseptic and replacement technique, improved operative and long-term antibiotic prophylaxis, careful follow-up with respect to anticoagulation, especially during the first year, and continued efforts in the quest for more durable and thromboresistant prosthetic heart valves.