The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 502-510, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Late sudden cardiac death in the follow-up of patients having a heart valve prosthesis
L Alvarez, C Escudero, D Figuera and JL Castillo-Olivares
Service of Experimental Surgery, Hospital Puerta de Hierro, Madrid, Spain.
Eight hundred thirty-one patients with Bjork-Shiley prostheses (341 aortic,
345 mitral, and 145 double) had a mean follow-up time of 68.2 months per
patient. Of these, 24 (16% of all deaths) died suddenly: six of 42 with
aortic valve replacement (14.3%), 12 of 56 with mitral valve replacement
(21.4%), and six of 36 with double valve replacement (16.6%). This
correlated with evidence of premature ventricular complexes detected in
multiple routine 12-lead follow-up electrocardiograms (p less than 0.001
for simple aortic or mitral valve replacements and p less than 0.01 for
combined aortic and mitral valve replacements). Premature ventricular
complexes were significantly more frequent among those who died suddenly
than among survivors and those who died of other causes (p less than 0.001
in both cases); there were no significant differences between the latter
two groups. The actuarial risk of sudden death was significantly greater
among those patients who had premature ventricular complexes than among
those who did not have this disorder (p = 0.0002). We conclude that the
presence of premature ventricular complexes, as an independent variable,
was correlated with the risk of sudden death.
