Aortic and mitral annular remodeling using ultrasonic decalcification

Mitral and particularly aortic valve replacements may be complicated by heavy calcification of the anulus, markedly impairing proper valve seating. From 1987 to 1996, we have used ultrasonic energy with the CUSA-device in valvular replacement to debride the aortic anulus in 90 patients and the mitral anulus in 2 patients. Annular debridement using ultrasonic decalcification is superior to other methods of debridement because it is safer, more thorough, and affords improved seating of the valve. As a result, placement of a larger valve is possible within a more compliant, wider anulus. There have been 0% incidence of paravalvular leak or valve failure. The operative mortality in our series was 1/92 (1.1%). Other than the fatality, the incidence of permanent stroke was 0%. Ultrasonic debridement to remodel the aortic and mitral valve anulus has been an invaluable adjunct in the heavily calcified anulus.