Thromboembolic complications of prosthetic cardiac valves.

Our experience with thromboembolism in 283 patients surviving at least 1 week following insertion of Starr-Edwards valves is reported here. Of these patients, 155 underwent aortic valve replacement, 21 had aortic valve replacement with mitral commissurotomy, 80 had mitral replacement, and 27 had both aortic and mitral valve replacement. Complete follow-up data were obtained on all patients, from 3 to 49 months following surgery (mean, 20 months). Thromboembolic episodes developed in 68 of the 283 patients (24%). Seventeen of these 68 patients died (25%), three had serious neurological residual (4%), but the majority of survivors recovered completely. Use of long-term anticoagulant therapy appeared to reduce incidence of embolic episodes only in patients with aortic valve replacement. Control of anticoagulant therapy (good, fair, or poor) bore no relationship to incidence of embolism within this group. Anticoagulant therapy in untreated patients with emboli reduced the incidence of subsequent thromboembolism. Hemorrhagic complications occurred in 23 patients (8%); one died. Thromboembolism is a serious complication of prosthetic valves. Its incidence in some patients is reduced but not eliminated by anticoagulant therapy.