Minimally Invasive Transaortic Mitral Decalcification for Extended Aortic Valve Calcifications
Toshinori Totsugawa1, Masahiko Kuinose2, Arudo Hiraoka1, Kentaro Tamura1, Hidenori Yoshitaka1, Taichi Sakauchi1.
1The Sakakibara Heart Institute of Okayama, Okayama, Japan, 2Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan.
OBJECTIVE: Extended aortic valve calcifications to the left ventricular outflow tract (LVOT) increase the risk of annulus rupture or paravalvular leak in transcatheter aortic valve replacement. Here we demonstrate the efficacy of transaortic mitral decalcification (TMD) during minimally invasive aortic valve replacement (MIAVR).
METHODS: The extended calcifications to the LVOT were carefully removed with an ultrasonic aspirator prior to MIAVR. From May 2007 to April 2016, 97 patients with aortic stenosis (AS) underwent MIAVR via right mini-thoracotomy. Eighteen patients (19%) underwent MIAVR after TMD (TMD group). Perioperative outcome of these patients was compared with that of remaining 79 patients who underwent MIAVR without TMD (control group).
RESULTS: In TMD group, 10 patients (56%) were octogenarians and 4 patients (22%) had mitral stenosis due to extended calcifications. Preoperative peak aortic valve pressure gradient in TMD group was significantly higher than that in control group. There were no cases of TMD-related complications such as leaflet perforation, stroke due to fallen debris, and paravalvular leak. The aortic cross-clamping time in TMD group was significantly longer than that in control group; however, there were no significant differences between two groups in in-hospital mortality, ventilation time, and length of hospital stay.
CONCLUSIONS: Minimally invasive TMD is a safe and secure procedure for the treatment of AS with extended calcifications.
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