Bjork-Shiley convexo-concave valve: is a prophylactic re-replacement justified?

Background. The Bjork-Shiley convexo-concave (BS-CC) heart valves represent the improved model of the standard valve first introduced with a different design of the disc valve to ameliorate hemodynamic performances and reduce thromboembolic complications. About 86,000 BS-CC were implanted during 197 9-1986 and of them a small number developed an intrinsic dysfunction result ing in sudden death. Methods. From 1979 to 1986 we implanted in 117 patients (48 males, 69 femal es, mean age 46.35 +/- 12.47, range 8-65 years) 125 BS-CC, In 38.5% (45/117 ) of the cases heart valve replacement represented the second cardiac proce dure after a previous closed heart digital commissurotomy, The mean size of the implanted prosthesis was 25.6 +/- 2.8 for aortic valve and 29.5 +/- 1. 2 for mitral valve. Results. Hospital mortality was 4.27% (5/117) and survival rate at 10 years is 71.4% and at 17 years 54.7% (Kaplan-Meier). At follow-up causes of deat h proved valve related in most of the patients but with no evidence of valv e fracture. We had I case of sudden death in patients at high risk (largest size, aortic position) and 30 cases of death by unknown causes but they di d not have an autopsy to confirm the cause of death, Conclusions. We conclude that in our population with BS-CC at the moment th ere is no indication for prophylactic replacement because of the higher ris ks of a reoperation (third or fourth in the 35.4% of our patients) than a s trut fracture. Nevertheless we believe an autopsy mandatory in all these pa tients at risk, when sudden death occurs.