Use of intraventricular ribbon gauze to reduce particulate emboli during aortic valve replacement

The incidence of cerebrovascular accidents following aortic valve surgery remains a devastating complication. The aim of this study was to determine the number of potential embolic material arising during aortic valve replacement and to examine the efficacy of using ribbon gauze in the left ventricle during removal of the native valve and decalcification of the aortic annulus.

Ribbon gauze was inserted into the left ventricular cavity prior to aortic valve excision in an unselected, prospectively studied series of 30 patients undergoing aortic valve replacement. A further 30 lengths of ribbon gauze were soaked in the pericardiotomy blood of the same patients and all were subjected to histological analysis.

The median number of tissue fragments from the aortic valve replacement group was significantly higher than in the control group 5 (0-18) versus 0 (0-1) (p = 3.6 x 10(-5)). The size of tissue fragments varied between 0.1 and 9.0 mm with a mean of 0.61 +/- 1.12 mm and a median of 0.2 mm. There was a significantly higher number of tissue fragments associated with patients having surgery for aortic stenosis when compared with patients who had aortic regurgitation with median of 5 (0-18) versus 0 (0-3) (p = 0.8 x 10(-3)).

Significant capture of particulate debris by the intraventricular ribbon gauze suggests that the technique of left ventricular ribbon gauze insertion during aortic valve excision has merit.