Abrasion-debridement of aortic valve calcific stenosis. Immediate and mid-term clinical results

Ultrasonic debridement of aortic valve calcific stenosis has been abandoned because of high incidence of late insufficiency, due to retraction of cusps damaged by ultrasonic energy. The feasibility of alternative decalcification technique has been tested at the Department of Thoracic and Cardiovascular Surgery of the University of Siena, Italy, using the abrasive power of a diamond burr, actioned by electrical high speed motor.

Between January 1995 and March 1996, fifteen patients underwent aortic decalcification. Mean age was 69.6 years.

All were symptomatic and 46% had associated coronary or mitral valve disease. Mean preoperative peak systolic echo-cardiographic gradient was 76+/-24.2 mmHs and valve area 0.87+/-0.31 at echoplanimetry. No moderate to severe aortic insufficiency was allowed. Valve debridement was achieved without mortality and morbidity procedure-related. Transvalvular hemodynamic gradient disappeared in 8 patients and fell in 7 from a mean value of 81.5 to 29.7 mmHg. The valvular area increased to a mean value of 2.4 cm2. At mid-term follow-up (mean 16.9 months, range 12 to 25) all patients remained clinically improved and free of complications. No case of new aortic incontinence nor worsening has been observed at echocardiographic control. The valve area was calculated 1.54+/-0.47 by continuity equation.

Although these results are encouraging, more experience and longer follow-up are necessary, before giving affordable guide-lines regarding the indication for abrasion-debridement technique in a clinical setting.