Annular Debridement Using An Ultrasonic Aspirator In Minimally Invasive Aortic Valve Replacement
Toshinori Totsugawa, Arudo Hiraoka, Kentaro Tamura, Hidenori Yoshitaka, Taichi Sakaguchi.
The Sakakibara Heart Institute of Okayama, Okayama, Japan.
OBJECTIVE: Annular debridement is a key procedure in minimally invasive aortic valve replacement (MIAVR) for aortic stenosis (AS). Ultrasonic aspirator is a surgical device utilizing ultrasonic vibrations to fragment the calcified tissue combined with an aspirator. Here we demonstrate annular decalcification using an ultrasonic aspirator in MIAVR.
METHODS: From September 2012 to August 2017, 105 patients underwent isolated aortic valve replacement via a right anterolateral mini-thoracotomy for AS. Intraoperative videos were recorded in 80 patients and annular debridement was reviewed in the videos. Our debridement procedure is as follows. First, the aortic valve was excised with a long scissors with enough valve tissue left. Then the well-seen annular calcification was removed using an ultrasonic aspirator. The hidden aortic annulus was exposed by means of traction of the decalcified remnant annular tissue and was debrided with the ultrasonic aspirator. After decalcification, remnant valve tissue was completely resected using the long scissors.
RESULTS: Mean age was 73±10 (range, 46-89) years old and male/female ratio was 33/47. There were 29 cases of bicuspid valve (36%). The mean aortic valve pressure gradient was 49±16 mmHg and aortic valve area was 0.74±0.20 cm2. Calcification at the left ventricular outflow tract was found in 20 patients (25%). Mean times of operation and cross-clamping were 261±35 and 101±15 min, respectively. Debridement time including valve excision, annular decalcification using an ultrasonic aspirator, and trimming of the remnant tissue was 14±5 (range, 5-32) min. Debridement time in bicuspid cases was significantly longer than that in tricuspid cases (17.9±5.5 vs 12.3±4.1 min, p<0.0001). There was no case of annular injury, mitral leaflet injury, paravalvular leakage, and cerebral infarction. Mean effective orifice area index (EOAI) was 1.00±0.16 cm2/m2. Moderate prosthesis-patient mismatch (PPM) (EOAI, 0.65-0.85 cm2/m2) was found in 16 patients (20%); however, there was no case of severe PPM (EOAI, <0.65 cm2/m2) in the present study.
CONCLUSIONS: Ultrasonic aspirator allowed easy and secure decalcification without injury of the adjacent annular tissue and could be a useful tool for MIAVR for AS.
Back to 2018 ePosters