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Aortic valve decalcification for severe aortic valve stenosis in the elderly: medium-term results

Garatti, Andrea; Canziani, Alberto; Menicanti, Lorenzo; Tripepi, Sonia; Simeoni, Simone; Mossuto, Eugenio; Santoro, Tiberio; Montericcio, Vincenzo; Pelissero, Gabriele

Journal of Cardiovascular Medicine: February 2016 - Volume 17 - Issue 2 - p 130–136
doi: 10.2459/JCM.0000000000000281
Cardiac surgery

Aims To present the results of a novel technique of aortic valve decalcification (AVD) in a consecutive population of elderly patients with severe aortic valve stenosis (AVS) and small aortic annulus.

Methods Between January 2008 and December 2012, a consecutive series of 34 patients (mean age 80 ± 13 years) with severe AVS were operated on using AVD. They were compared with a matched population of 68 patients (mean age 82 ± 7 years) submitted to aortic valve replacement (AVR) with bioprosthesis. The two groups were comparable for cardiac risk factors and admission symptoms. Preoperatively, all patients presented with severe AVS, small aortic annulus (19 mm) and preserved left ventricular function.

Results Thirty-day mortality was 8.8 vs. 7.5% in the AVD and AVR groups, respectively (P = 0.88). Actuarial 2 and 5-year survival rates were 80 vs. 82% and 64 vs. 78% in the AVD and AVR groups, respectively (P = 0.27). Long-term valve-related events incidence was significantly higher in the AVD group (12%) compared with that in the AVR group (4%; P = 0.01). However, in the AVD group, patients with no or mild residual AR experienced 2 and 5 years of freedom from valve-related events, which is not significantly different from the patients submitted to the AVR group (P = 0.76). After AVD, a significant increase in the aortic valve area (from 0.8 to 1.9 cm2) and a parallel reduction in the mean gradient (from 40 to 12 mmHg) was observed in all patients (P = 0.01). Postoperative aortic valve area (1.9 vs. 1.26 cm2), as well as mean gradient (12 vs. 21 mmHg), were significantly better in the AVD group compared with that in the AVR group (P = 0.01).

Conclusion In this preliminary experience, AVD seems a good therapeutic option for elderly patients with severe AVS. Further studies with longer follow-up are needed in order to confirm these preliminary results and to ascertain the valve durability over time.

aCardiac Surgery II Unit

bEchocardiography Laboratory

cScientific Directorate, IRCCS Policlinico San Donato, Milan

dDivision of Cardiology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

Correspondence to Andrea Garatti, MD, Department of Cardiovascular Disease ‘E. Malan’, Cardiac Surgery Unit, Policlinico S. Donato Hospital, Via Morandi 30, 20097, S. Donato Milanese, Milan, ItalyTel: +39 02 52774393; fax: +39 02 52774327; e-mail: agaratti@tiscali.it

Received 24 September, 2014

Revised 17 February, 2015

Accepted 12 March, 2015

© 2016 Italian Federation of Cardiology. All rights reserved.