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Ultrasonic decalcification of calcified valve and annulus during heart valve replacement
M Unal1, I Sanisoğlu, C Konuralp
1Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
Insights
Ultrasonic decalcification effectively removes heart valve calcifications, reducing complications after prosthetic valve replacement surgery. This advanced technique offers a superior alternative to traditional methods for improved patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Heavily calcified heart valve annuli are associated with increased risks of complications following prosthetic valve replacement.
- These complications include cerebral embolism, paravalvular leakage, and valvular dysfunction.
Purpose of the Study:
- To evaluate the efficacy of ultrasonic surgical aspiration for decalcifying heavily calcified heart valve annuli prior to prosthetic valve replacement.
- To assess the incidence of sequelae after valve replacement using ultrasonic decalcification.
Main Methods:
- A cohort of 30 patients with heavily calcified heart valve annuli underwent prosthetic valve replacement between January 1991 and June 1994.
- Ultrasonic surgical aspiration was employed to remove calcific deposits from the annuli before prosthesis implantation.
- Procedures included aortic valve replacement (12 patients), mitral valve replacement (13 patients), and combined aortic and mitral valve replacement (5 patients).
Main Results:
- Post-operative echocardiographic examinations at 6 months revealed no instances of paravalvular leakage or other valve-related complications in any of the 30 patients.
- Ultrasonic decalcification demonstrated a favorable safety and efficacy profile in managing calcified annuli.
Conclusions:
- Ultrasonic decalcification of the heart valve annulus is a superior method compared to traditional techniques for managing calcified annuli during valve replacement surgery.
- The study advocates for the routine use of ultrasonic débridement as an adjunctive tool in prosthetic heart valve replacement procedures involving calcified annuli.
Abstract:
A heavily calcified heart valve annulus increases the likelihood of sequelae after prosthetic valve replacement. Such sequelae include cerebral embolism, paravalvular leakage, valvular dysfunction, rhythm disturbance, hemolysis, communication of the heart chambers, and rupture of the posterior wall of the left ventricle. From January 1991 through June 1994, we performed heart valve replacement on 30 patients, using an ultrasonic surgical aspirator to remove calcific deposits. We placed aortic valve prostheses in 12 patients, mitral valve prostheses in 13 patients, and both aortic and mitral prostheses in 5 patients, after ultrasonic débridement of calcified annuli. All patients were re-examined 6 months after surgery: echocardiographic study showed no paravalvular leakage or valve-related complications. In our experience, ultrasonic decalcification of the annulus is superior to traditional methods. We advocate the use of ultrasonic débridement as an adjunctive tool in calcified heart valve replacement.