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 calcified aortic valve. In this study, we aimed to assess the
effectiveness of the FLS technique by comparing 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. 70 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 two groups. Compared with the conventional
technique, the FLS technique had significantly higher indexed effective
orifice area and lower mean gradient. Moreover, FLS technique was
associated with significantly reduced aortic cross-clamp time
(41[38-44] vs 56[51-60] min, p<0.001), cardiopulmonary
bypass (CPB) time (63[56-69] vs 81[75-84] min,
p<0.001) and operative time (148[141-156] vs
173[169-180] min, p<0.001). Lastly, the length of
intensive care unit stay (1.2±0.4 vs 1.5±0.8 days, p=0.041) and hospital
stay (5.3±0.6 vs 6.0±1.4 days, p=0.020) 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 conventional technique.