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Cardiac valve prostheses at autopsy
1Department of Pathology, Los Angeles County, University of Southern California Medical Center 90033.
Insights
Autopsy findings in 96 patients reveal prosthetic heart valves are most often indicated for rheumatic heart disease. Cardiac failure was the leading cause of death, with mechanical valves showing longer survival than bioprostheses.
Area of Science:
- Cardiovascular Pathology
- Medical Device Analysis
Background:
- Prosthetic heart valves are crucial for managing valvular heart disease.
- Understanding autopsy findings is vital for improving patient outcomes and device design.
Purpose of the Study:
- To detail the pathologic findings in patients who received prosthetic heart valves.
- To analyze causes of death and complications associated with these devices.
Main Methods:
- Autopsy examination of 96 individuals with prosthetic heart valves.
- Review of indications for valve implantation and causes of death.
Main Results:
- Rheumatic heart disease (58%) and infective endocarditis (22%) were primary indications.
- Cardiac failure caused two-thirds of deaths; prosthetic valve failure caused 8 deaths.
- Thrombosis was the most common complication (23% mechanical, 11% bioprosthetic); thromboembolic phenomena caused 9 deaths.
Conclusions:
- Autopsy provides critical insights into prosthetic heart valve performance and complications.
- Findings guide improved investigation, description, and diagnosis of prosthetic heart valves postmortem.
Abstract:
We describe the pathologic findings at autopsy in 96 persons who had undergone prosthetic heart valve implantation. The most common indication for implantation was rheumatic heart disease (58%), followed by infective endocarditis (22%). Cardiac failure led to death in two thirds of the cases, most often from infective endocarditis (18%) and congestive heart failure (13%). Failure of the prosthetic valve caused death in eight cases. There were 13 deaths intraoperatively or in the immediate postoperative period. Patients with mechanical prostheses survived longer than did those with bioprostheses. The most common prosthesis-related complication was thrombosis, found in 23% of mechanical valves and 11% of bioprostheses. Thrombosis led to death in only 4 cases. Thromboembolic phenomena led to nine deaths and were not related to anticoagulant therapy. These findings provide an approach to investigation, description, and diagnosis of prosthetic heart valves at autopsy.