Management of Mild or Moderate Calcific Aortic Valve Disease in Patients Undergoing Operation for Subaortic Obstruction.

BACKGROUND

This study sought to evaluate short- and long-term outcomes of aortic valve (AV) intervention by decalcification or replacement for the treatment of mild to moderate calcific AV stenosis (AS) in patients undergoing transaortic septal myectomy for subaortic left ventricular outflow tract (LVOT) obstruction.

METHODS

Between 2000 and 2023, study investigators identified 137 consecutive patients undergoing myectomy with or without membranectomy for mild to moderate calcific AS. Of these patients, 93 underwent surgical intervention on the AV and formed the primary cohort; 44 patients who did not undergo AV intervention were used as a control group. Subaortic LVOT obstruction was the primary indication for surgery.

RESULTS

The median age of patients with AV intervention was 71.3 years (range, 66.5-76.9 years), and 50.5% of the patients were female. Forty-four patients (47.3%) underwent AV decalcification, whereas 49 (52.7%) had AV replacement, with no significant differences in clinical features. Valvular cusp calcification was less extensive in the decalcification group (P < .001). Early postoperatively, AV gradients improved in both groups (each P < .001) to similar extents. No patients in the decalcification group experienced severe AV regurgitation. Rates of AV reintervention were similar between groups (P = .84) and were lower than in the control group. Long-term survival was comparable between both groups and matched patients who underwent isolated myectomy without AV disease.

CONCLUSIONS

Mild to moderate AS may complicate operative treatment of subaortic LVOT obstruction in adults. When surgical management is guided by visual determination of the extent of cusp calcification, AV decalcification yields good early hemodynamic results and late survival and reoperation rates similar to AV replacement.