Abstract

Senile, tricuspid aortic stenosis was relieved in 26 patients (2.6%) by ultrasonic debridement in 985 aortic valve procedures between January 1990 and October 1995. There were 15 females and 11 males, aged 59 to 81 years (mean, 74). As a concomitant diagnosis, 23 patients (88%) had mostly mild, aortic valve insufficiency, 16 (61%) had coronary artery disease and 11 (42%) had mitral valve incompetence. Two operative deaths occurred and 6 patients died later. The follow-up period ranged from 16 to 73 months (mean, 29). Postoperative Doppler echocardiography showed immediately after surgery and 29 months later a decrease in peak and mean gradients across the aortic valve, three- and two-fold respectively (p<0.001). Twenty-nine months after debridement we observed a mild rise in both gradients (at peak gradient p<0.05). Directly postoperatively, the aortic valve area increased doubly and 29 months later it slightly decreased, but statistically significant in comparison with the preoperative data (p<0.001). Follow-up echocardiography demonstrated late onset of moderate aortic valve insufficiency in 6 patients and in 1 patient aortic valve restenosis required re-operation. The classification of New York Heart Association (NYHA) was improved in 13 (72%) survivors after 29 months. Only one patient showed deteriovation in his functional status. The advantage of preserving the native aortic valve in elderly patients is an argument in favour of period aortic valve reconstruction in selected patients. Longer follow-up is necessary, however, to establish this procedure as treatment of choice.

Keywords: aortic stenosis, reconstruction, Surgery, follow-up