In vitro decalcification of aortic valve leaflets with the Er:YSGG laser, Ho:YAG laser, and the Cavitron ultrasound surgical aspirator.
This study was designed to compare the efficacy of the erbium:yttrium-scandium-gallium-garnet (Er:YSGG) laser and the holmium:yttrium-aluminum-garnet (Ho:YAG) lasers in debriding calcium from freshly explanted aortic valve leaflets and to compare the Er:YSGG laser with the Cavitron ultrasonic surgical aspirator (CUSA). Aortic valve leaflets were freshly explanted from patients undergoing aortic valve replacement for aortic stenosis. Initially, 4 leaflets each were debrided with the Er:YSGG and the Ho:YAG lasers to attempt removal of calcium deposits while preserving the underlying integrity of the leaflets and minimizing thermal damage. The Er:YSGG laser was more effective in doing so with less thermal and photoacoustic damage when compared with the Ho:YAG laser. Twelve more leaflets each were then debrided with the Er:YSGG laser and the CUSA. The Er:YSGG laser again proved less injurious to the underlying leaflet. The CUSA-treated leaflets demonstrated shattering and disruption of adjacent tissue as well as collagen fiber exposure. These changes were not seen with the Er:YSGG laser. Because of these properties, the Er:YSGG laser merits further evaluation as a tool for aortic valvuloplasty procedures in selected patients with senescent calcific aortic stenosis.
Williamson
W A
WA
Department of Thoracic and Cardiovascular Surgery, Lahey-Clinic Medical Center, Burlington, Massachusetts 01805.
Aretz
H T
HT
Weng
G
G
Shahian
D M
DM
Hamilton
W M
WM
Pankratov
M M
MM
Shapshay
S M
SM
D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D002114:Calcinosis / Q000473:pathology / Q000601:surgery*; D003646:Debridement; D006801:Humans; D066298:In Vitro Techniques; D053685:Laser Therapy; D014464:Ultrasonic Therapy