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The Annals of Thoracic Surgery, Vol 54, 62-67, Copyright © 1992 by The Society of Thoracic Surgeons

ARTICLES

Combined conventional mechanical and ultrasonic debridement for aortic valvular stenosis

OR Baeza, NK Majid, DP Conroy and JS Donahoo
Eastern Heart Institute, General Hospital Center, Passaic, New Jersey.

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)

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