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-alumin um-garnet (Ho:YAG) lasers in debriding calcium from freshly explanted aortic valve leaflets and to compare the Er:YSGG laser with the Cavitr on ultrasonic surgical aspirator (CUSA). Aortic valve leaflets were fr eshly 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 whil e preserving the underlying integrity of the leaflets and minimizing t hermal damage. The Er:YSGG laser was more effective in doing so with l ess thermal and photoacoustic damage when compared with the Ho:YAG las er. Twelve more leaflets each were then debrided with the Er: YSGG las er 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 p roperties, the Er:YSGG laser merits further evaluation as a tool for a ortic valvuloplasty procedures in selected patients with senescent cal cific aortic stenosis. (C) 1993 Wiley-Liss, Inc.