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J Thorac Cardiovasc Surg 1999;117:1157-1165
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

MANUAL DEBRIDEMENT OF THE AORTIC VALVE IN ELDERLY PATIENTS WITH DEGENERATIVE AORTIC STENOSIS

From the Departments of Cardiovascular Surgery and Medicine, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation, Buenos Aires, Argentina.

Received for publication April 10, 1998. Revisions requested May 20, 1998. Revisions received March 1, 1999. Accepted for publication March 1, 1999. Address for reprints: Ernesto Eduardo Weinschelbaum, MD, Department of Cardiovascular Surgery, Favaloro Foundation, Belgrano 1746, 1093 Buenos Aires, Argentina.

Objective: We prospectively analyzed the short- and long-term results of manual debridement of the aortic valve in elderly patients with severe degenerative aortic stenosis.
Methods: Between September 1988 and January 1997, 103 patients aged 73.7 ± 6 years with degenerative aortic stenosis underwent the manual debridement technique. All had symptoms (angina or dyspnea, or both). Peak systolic gradient was 89 ± 28 mm Hg. Forty-one patients (39.8%) had associated coronary artery disease necessitating revascularization.
Results: Follow-up time was 42 ± 21 months (range 3-98 months). The Kaplan-Meier estimated survival at 98 months was 50% (95% CI: 30%-70%). In-hospital mortality was 5.8% (6 patients), and late mortality was 21% (21 patients). No predictors of in-hospital mortality or of late mortality were detected. Nonfatal postoperative complications appeared in 25 patients (24%). At 8 years, freedom from endocarditis was 98% (95% CI: 95%-100%) and freedom from thromboembolic events was 99% (95% CI: 96%-100%). No patient required long-term anticoagulation as a result of the procedure. Fourteen patients (14%) required reoperation for aortic insufficiency (n = 5), restenosis (n = 8), and mitral regurgitation (n = 1). The probability of reoperation at 98 months was 23% (95% CI: 12%-35%).
Conclusion: Manual aortic valve debridement has low rates of in-hospital mortality, perioperative complications, and thromboembolic and infectious events and it offers freedom from anticoagulation. However, the incidence of restenosis and reoperation is high in the long term. It may therefore be regarded as an alternative in aged patients with favorable valve anatomy (no distortion and calcium deposits only on the aortic surface of the cusps), especially in those with a small aortic anulus, associated coronary artery disease, and/or contraindication for anticoagulation.