European Journal of Cardio-Thoracic Surgery, Vol 10, 498-504, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Aortic valve debridement by ultrasonic surgical aspirator in degenerative, aortic valve stenosis: follow-up with Doppler echocardiography
HJ Kellner, P Pracki, A Hildebrandt, C Binner, G Eisele and E Struck
Department of Cardiovascular Surgery, Augburg Medical Center, Germany.
OBJECTIVE: Recently there has been an emphasis on reconstructing diseases
native valves as an alternative to prosthetic valve replacement. Whereas;
the surgical repair of aortic valve stenosis has been always problematic.
This study was performed to estimate the clinical results after aortic
valve debridement using ultrasonic energy. METHODS: Between 1990-1994 26
patients underwent ultrasonic aortic valve decalcification. There were 15
females and 11 males, the age was in average 74 years. As a concomitant
diagnosis 88% patients (23) had mostly mild, aortic valve insufficiency, 16
(61%) had coronary artery disease and 11 (42%) had mild mitral valve
incompetence. All of the patients were operated with cardiopulmonary bypass
using moderate hypothermia, cardioplegical arrest and topical cooling for
myocardial protection. The calcifications were removed tangentially using
Cavitron Ultrasonic Surgical Aspirator. (CUSA), CAVITRON, USA. Leaflet
perforation and/or unsatisfactory valve closure have been indications for
aortic valve replacement. RESULTS: Two operative death (8%) have occurred
and six patients have died in the further course (follow-up mean 17 months
ranging from 4 to 61 months). Postoperative Doppler- Echocardiography
results taken directly after surgery and then again 17 months later (n =
18) showed a decrease of peak and mean gradients across the aortic valve
three and two times respectively (p < 0.001). 17 months after
debridement we observed a mild rise in both gradients (by peak gradient p
< 0.05). Directly postoperative, the aortic valve area increased doubly
and decreased 17 months later slight, but it was still statistically
significant in comparison with our preoperative data (p < 0.001).
Follow-up echocardiography demonstrated late onset of moderate aortic valve
insufficiency in 6 patients. The classification of New York Heart
Association was improved in 13 (72%) survivors after 17 months.
CONCLUSIONS: Ultrasonic debridement of aortic valve stenosis allows precise
and energy-controlled removal of calcium, increased doubly the valve area
and decreased of peak and mean gradients statistically significant. The
advantages of preserving the native aortic valve in elderly patients are
relative good arguments; although a longer follow-up is necessary to
establish this procedure.
