Mortality and Pathology Following Aortic Valve Replacement with the Björk-Shiley Tilting Disc Valve

Abstract

The cause of death and the main pathology in 20 patients following 161 aortic valve replacements with the Björk-Shiley tilting disc valve were evaluated by classical pathological methods. Hospital mortality was 5% (8 patients), while 7% (12 patients) died later. Myocardial failure (9 patients) was the predominant cause of death. The remainder died of cerebral haemorrhage (3 patients), malignancy (3), infection (2), dissecting aortic aneurysm (1), hepato-renal syndrome (1) and thromboembolism in the absence of anticoagulant treatment (1). Gross cardiomegaly was found in all the 20 hearts examined. The low rate of prosthetic problems is ascribed to the design of the Björk-Shiley tilting disc valve with its excellent wear characteristics and long durability. The absence of intimal changes in the area of the coronary ostia is also attributed to its construction with a low gradient, laminar flow and minimal turbulence. With anticoagulant treatment in long-term survivors with the Björk-Shiley valve in the aortic position no thromboembolic complication has been encountered. Coronary perfusion during aortic valve replacement is considered of great importance in reducing the incidence of massive subendocardial myocardial necrosis.