The benefit of fibrosa layer stripping technique during minimally invasive aortic valve replacement for calcified aortic valve stenosis—A randomized controlled trial

Abstract

Background: Fibrosa layer stripping (FLS) technique is a new approach to remove the calcified aortic valve. In this study, we aimed to assess the effectiveness of the FLS technique by comparing it with the conventional technique in minimally invasive aortic valve replacement (MIAVR). Methods: A prospective, single-center, randomized controlled trial was conducted at Beijing Anzhen Hospital. Seventy patients diagnosed with severe calcific aortic stenosis were randomly assigned to undergo FLS (n = 35) or conventional (n = 35) technique to debride calcified aortic valve. Preoperative profile, procedural parameters, and postoperative outcomes were analyzed. Results: No significant difference was observed in the preoperative profile between the two groups. Compared with the conventional technique, the FLS technique had a significantly higher indexed effective orifice area and lower mean gradient. Moreover, the FLS technique was associated with significantly reduced aortic cross-clamp time (41 [38-44] vs. 56 [51-60] min, p < .001), cardiopulmonary bypass (CPB) time (63 [56-69] vs. 81 [75-84] min, p < .001), and operative time (148 [141-156] vs. 173 [169-180] min, p < .001). Lastly, the length of intensive care unit stay (1.2 ± 0.4 vs. 1.5 ± 0.8 days, p = .041) and hospital stay (5.3 ± 0.6 vs. 6.0 ± 1.4 days, p = .020) was significantly reduced in the FLS group compared with those in the conventional group. Conclusions: FLS technique is effective in removing calcified tissue during MIAVR and is associated with shorter cross-clamp time and CPB time, and better hemodynamic performance than the conventional technique.

Double-layer horizontal cross sutures for intra-atrial mitral valve implantation: An effective surgical method for severe mitral annular calcification

“…Initially, the aortic annulus and aortomitral curtain calcification were removed first using a previously reported fibrosa layer stripping technique ( Figure E2 ). 12 Following this, a transverse incision in the aorta, extending into the anterior mitral leaflet, was made according to the method of Manouguian. 13 This procedure was succeeded by aortomitral curtain extension using a Dacron patch, widening the mitral and aortic annulus to prevent patient–prosthesis mismatch.…”