Management of patients with asymptomatic moderate aortic stenosis undergoing coronary artery bypass grafting
Gilles D Touati1, Doron Carmi, Faouzi Trojette
1Department of Cardiovascular Surgery, Centre Hospitalier et Universitaire d'Amiens, Hĵpital Sud, France.
Insights
Manual decalcification of the aortic valve is a viable option for patients with moderate aortic stenosis undergoing coronary artery bypass grafting. This procedure can improve aortic valve area and potentially delay stenosis progression.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Moderate aortic stenosis (AS) often coexists with coronary artery disease.
- Surgical intervention for coronary artery disease presents an opportunity to address concomitant AS.
Purpose of the Study:
- To evaluate manual aortic valve decalcification as a treatment for moderate AS during coronary artery bypass grafting (CABG).
- To assess if manual valve debridement can delay the natural progression of AS.
Main Methods:
- Prospective study of 14 adult patients with moderate AS undergoing CABG.
- Manual debridement of aortic valve calcifications and restoration of cusp mobility.
- Concomitant myocardial revascularization with an average of 2.38 grafts per patient.
Main Results:
- Significant improvement in mean aortic valve area index (AVAI) post-surgery (0.56 to 1.43 cm²/m²).
- Slowest recalcification rates observed in patients with specific AVAI ratios, minimal change in aortic insufficiency, and higher preoperative AVAI (>0.55 cm²/m²).
Conclusions:
- Manual aortic valve decalcification is a beneficial option for moderate AS in patients requiring CABG.
- Optimal outcomes achieved in patients with senile tricuspid aortic valve stenosis and AVAI of 0.55-0.9 cm²/m².
Background And Aims Of The Study:
Manual decalcification of the aortic valve was performed systematically in a prospective series of patients with asymptomatic moderate aortic stenosis (AS) undergoing coronary artery bypass grafting (CABG). This study addressed two main issues: (i) whether aortic valve decalcification is a good option to relieve moderate AS; and (ii) whether the natural progression of AS may be delayed by manual valve debridement when surgery is indicated for coronary disease.
Methods:
Between October 1997 and March 2001, 14 adult patients with moderate AS underwent concomitant surgical repair of the aortic valve during CABG. Manual valve debridement with restoration of cusp mobility was attempted. Calcified deposits were removed by careful dissection. All patients underwent myocardial revascularization; a mean of 2.38 grafts was performed per patient.
Results:
Immediately after surgery, mean aortic valve area index (AVAI) was improved, from 0.56+/-0.12 to 1.43+/-0.25 cm2/m2. Patients with the slowest recalcification rates were those with a postoperative/preoperative AVAI ratio of 1.6 to 2.4, those in whom the degree of postoperative aortic insufficiency was very similar to the degree of preoperative regurgitation, and those in whom the preoperative AVAI was >0.55 cm2/m2.
Conclusion:
Manual aortic valve debridement for moderate AS is a good option when surgery must be performed for coronary disease; the best results were obtained in patients with senile stenosis of a tricuspid aortic valve with an AVAI of 0.55-0.9 cm2/m2.
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