Related Experiment Videos
Combined conventional mechanical and ultrasonic debridement for aortic valvular stenosis
O R Baeza1, N K Majid, D P Conroy
1Eastern Heart Institute, General Hospital Center, Passaic, New Jersey.
Insights
Ultrasound decalcification effectively treated severe aortic stenosis by significantly reducing valve gradients and increasing valve area. This minimally invasive approach shows promise for patients with calcific aortic stenosis.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Ultrasound
Background:
- Severe calcific aortic stenosis (AS) poses a significant clinical challenge.
- Traditional treatments may carry substantial risks for certain patient populations.
- Novel minimally invasive techniques are needed to improve AS management.
Purpose of the Study:
- To evaluate the feasibility and efficacy of ultrasound decalcification for severe calcific aortic stenosis.
- To assess the impact of the procedure on aortic valve gradients and area.
- To determine the safety and outcomes of ultrasound decalcification.
Main Methods:
- Ultrasound decalcification was performed on 31 patients with severe AS.
- Echocardiography assessed valve function and regurgitation pre- and post-procedure.
- Transseptal aortic valve gradients and aortic valve area (AVA) were measured.
Main Results:
- Aortic valve gradient decreased from 72.5 +/- 22.5 mm Hg to 15.5 +/- 11.9 mm Hg.
- Average AVA increased from 0.41 +/- 0.10 cm2 to 1.55 +/- 0.58 cm2.
- Mortality rates were 6.45% early and 6.45% late, unrelated to the procedure.
Conclusions:
- Ultrasound decalcification is a feasible and effective method for treating severe calcific aortic stenosis.
- The procedure significantly improves hemodynamic parameters of the aortic valve.
- This technique offers a promising alternative for AS management with acceptable safety.
Abstract:
Ultrasound decalcification of aortic valve stenosis was performed in 31 patients. There were 16 men and 15 women with a mean age of 71.03 +/- 9.6 years (range, 51 to 89 years). Each had severe calcific aortic stenosis with an aortic valve gradient greater than 40 mm Hg, aortic valve area (AVA) less than 0.6 cm2, and no serious insufficiency. Feasibility of aortic valve debridement was determined under direct vision. Intraoperative epicardial or transesophageal color Doppler two-dimensional echocardiography was used before and after the aortic valve debridement to evaluate aortic cusp motion and aortic regurgitation. Direct transseptal aortic valve gradient was measured on all patients before and after aortic valve debridement, and the AVA was determined. Aortic valve debridement was performed as the primary procedure in 17 cases and combined with other cardiac procedures in 14 patients. Preoperative aortic valve gradient was reduced from 72.5 +/- 22.5 mm Hg (range, 40 to 130 mm Hg) to 15.5 +/- 11.9 mm Hg (range, 2 to 50 mm Hg), and the average AVA of 0.41 +/- 0.10 cm2 (range, 0.22 to 0.63 cm2) was increased to 1.55 +/- 0.58 cm2 (range, 0.65 to 3.50 cm2) after ultrasound decalcification. There were two early deaths in octogenerian, high-risk patients, and two late deaths (6.45% early and 6.45% late mortality), none of them related to AVD. Postoperative follow-up included clinical evaluation and color Doppler echocardiography every 6 months. The aortic valve gradient was measured using a continuous-wave Doppler probe, and the AVA was calculated by the simplified continuity equation: AVA = aAOA x vLVOT/vAV.(ABSTRACT TRUNCATED AT 250 WORDS)