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Fatal degeneration of silicone rubber balls of Starr-Edwards prosthetic aortic valves is described in 11 of 271 patients who underwent aortic valve replacement. Among 35 autopsy subjects, none of the 23 who died less than 24 months after operation had evidence of ball degeneration, whereas severe degeneration was present in 11 of 12 patients who died more than 24 months after operation. In 6 patients the ball had atrophied, fractured and become dislodged from the cage, and in 5 it had swollen and become impacted within the cage.
Degeneration of the silicone rubber ball may be an inevitable late complication of replacement of the aortic valve with a Starr-Edwards prosthesis. Therefore, reoperation and replacement of these degenerated aortic balls will be necessary in many patients. The ideal time for reoperation, however, is not yet determined. Whether the use of a hollow metal ball will prevent this complication remains to be seen.
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