TY - JOUR
T1 - Aortic valve decalcification for severe aortic valve stenosis in the elderly
T2 - Medium-term results
AU - Garatti, Andrea
AU - Canziani, Alberto
AU - Menicanti, Lorenzo
AU - Tripepi, Sonia
AU - Simeoni, Simone
AU - Mossuto, Eugenio
AU - Santoro, Tiberio
AU - Montericcio, Vincenzo
AU - Pelissero, Gabriele
PY - 2016
Y1 - 2016
N2 - 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 12mmHg) was observed in all patients (P U 0.01). Postoperative aortic valve area (1.9 vs. 1.26 cm2), as well as mean gradient (12 vs. 21mmHg), 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.
AB - 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 12mmHg) was observed in all patients (P U 0.01). Postoperative aortic valve area (1.9 vs. 1.26 cm2), as well as mean gradient (12 vs. 21mmHg), 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.
KW - Aortic valve regurgitation
KW - Aortic valve repair
KW - Aortic valve stenosis
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U2 - 10.2459/JCM.0000000000000281
DO - 10.2459/JCM.0000000000000281
M3 - Article
C2 - 26258720
AN - SCOPUS:84953240527
VL - 17
SP - 130
EP - 136
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
SN - 1558-2027
IS - 2
ER -