February 18, 1983

Autopsy-Determined Causes of Death After Cardiac Valve Replacement

Author Affiliations

From the Department of Pathology, University of Florida College of Medicine, Gainesville (Dr Schoen); and the Departments of Pathology (Dr Titus) and Surgery (Dr Lawrie), The Methodist Hospital, Baylor College of Medicine, Houston. Dr Schoen is now with the Department of Pathology, Brigham and Women's Hospital, Boston. During part of this study, Dr Schoen was a Clinical Training Fellow in Thoracic and Cardiovascular Pathology of the American Lung Association.

JAMA. 1983;249(7):899-902. doi:10.1001/jama.1983.03330310029021

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.

(JAMA 1983;249:899-902)