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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 Ottobre;39(5):667-72

CARDIAC PAPERS 

 TECHNICAL NOTES

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

Mez­za­ca­po B.

From the Institute Multichair of Thoracic and Cardiovascular Surgery Chair of Cardiosurgery University of Siena, Siena, Italy

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

lingua: Inglese


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