Back to 2017 Cardiac Track Overview

Ultrasonic decalcification in cardiac surgery.
Alina Stan, Ragi Nagib, Hardy Baumbach, Adrian Ursulescu, Samir Ahad, Nora Göbel, Ulrich F.W Franke
Department of Cardiovascular Surgery, Robert-Bosch-Hospital Stuttgart, Germany
Objective: Calcification of heart structures may provoke challenging problems in patients undergoing cardiac surgery. The aim of this study was to evaluate the efficacy and safety of an Ultrasonic aspirator (Sonopet®, Striker, Germany). This surgical tool uses low frequency ultrasonic vibrations to fragment the calcified tissue combined with an aspirator.
Methods: From March 2013 to November 2016, 63 adult patients with challenging calcifications (aortic valve cusps, n=30, aortic annulus, n=2, mitral valve leaflets, n=3, mitral valve annulus, n=16, ascending aorta, n=3 and coronary ostia, n=9) underwent heart surgery with cardiopulmonary bypass. For decalcification the Sonopet was used.
Results: Mean age was 69.3 year (range 25-89), and 65 % were male. Mean CPB-time was 146.70±54.413 and mean Cross-clamp time was 103.51±42.800 in various cardiac procedures. Technical success of decalcification was achieved in 94 %. In 4 of 30 patients with aortic cusp decalcification the procedure was unsuccessful and aortic valve replacement was necessary. There was only one postoperative death after mitral valve replacement. There were no serious adverse events related to the application of the device. The additional time for the application of the Sonopet differed by indication (table). There was no need for re-operation during short-term follow-up.
Conclusions: Our results suggest that the intraoperative use of ultrasonic aspirator is useful for decalcification in cardiac surgery and allows precise and energy-controlled
removal of calcifications without destruction of the adjacent soft tissues. In conclusion, decalcification with this tool is safe and provides excellent results.

Decalcification operative times

No of Patients	Localization	Decalcification Time (min)
3	Sinotubular junction	6.67±2.082
30	Aortic valve cusps	11.10±6.890
2	Aortic annulus	9.50±0.707
3	Mitral valve leaflets	6.33±4.163
16	Mitral annuls	12.31±6.374
9	Left or right coronary ostium	8.89±4.045