Autopsy-determined causes of death after cardiac valve replacement
F. J. Schoen, J. L. Titus and G. M. Lawrie
We reviewed records of 378 patients who died after cardiac valve
replacement and underwent autopsy at The Methodist Hospital, Houston, from
1962 through 1979. Patients were divided according to postoperative
interval at death: within 30 days (early) or 30 days to ten years (late).
Early deaths (279 patients) were due almost exclusively to cardiovascular
abnormalities or operative complications (94%). Only 6% of early deaths
were caused by prosthesis-associated complications. In contrast, late
deaths (99 patients) were valve related in 47% of cases, including complete
thrombotic occlusion or systemic thromboembolism (21%), prosthetic valve
endocarditis (14%), valve dehiscence (6%), anticoagulation-related
hemorrhage (3%), and mechanical degeneration (2%). Nine percent of late
deaths were unrelated to cardiovascular disease. Thus, while early deaths
primarily reflected the severity of preexisting or associated
cardiovascular disease, prosthesis-associated complications were an
important cause of late death after cardiac valve replacement.
