Aortic valve reconstruction surgery with Ozaki technique: initials results from a single center / Cirugía de reconstrucción de válvula aórtica con técnica de Ozaki: resultados iniciales en un centro de referencia

Abstract Background: Aortic valve (AV) replacement is the gold standard treatment for severe symptomatic AV disease. Recently, AV reconstruction surgery (Ozaki procedure) emerges as a surgical alternative with good results in the medium term. Methods: We retrospectively analyzed 37 patients who underwent AV reconstruction surgery between January 2018 and June 2020 in a national reference center in Lima, Peru. The median age was 62 years, interquartile range (IQR: 42-68). The main indication for surgery was AV stenosis (62.2%), in most cases due to bicuspid valve (19 patients, 51.4%). Twenty-two (59.4%) patients had another pathology with surgical indication associated to AV disease, 8 (21.6%) had dilatation of the ascending aorta with indication for replacement. Results: One in-hospital death occurred (1/38, 2.7%) due to perioperative myocardial infarction. There was a significant reduction in the medians of the peak (70 mmHg, CI 95% = 50.03-79.86 vs. 14 mmHg, CI 95% = 11.93-17.5, p < 0.0001) and mean (45.5 mmHg CI 95% = 30.6-49.68 vs. 7 mmHg, CI 95% = 5.93-9.6, p < 0.0001) AV gradients when we compared baseline characteristics with first 30-days results. In an average of 19 (± 8.9) months of follow-up, survival, reoperation-free survival for valve dysfunction, and survival free of AV insufficiency ≥ II were 97.3%, 100% and 91.9%, respectively. Significant reduction in the medians of the peak and mean AV gradients was maintained. Conclusions: AV reconstruction surgery showed optimal results in term of mortality, reoperation-free survival, and hemodynamic characteristics of the neo-AV.

Resumen Introducción: El reemplazo de la válvula aórtica es el tratamiento de elección para la valvulopatía aórtica severa sintomática. Recientemente, la cirugía de reconstrucción valvular aórtica (procedimiento de Ozaki) emerge como una alternativa quirúrgica con buenos resultados a mediano plazo. Métodos: Analizamos retrospectivamente 37 pacientes intervenidos de reconstrucción de válvula aórtica entre enero de 2018 y junio de 2020 en un centro de referencia nacional en Lima, Perú. La mediana de edad fue de 62 años (rango intercuartílico: 42-68). La estenosis de la válvula fue la principal indicación de cirugía (62.2%), en la mayoría de los casos por válvula bicúspide (19 pacientes, 51.4%). 22 (59.4%) pacientes presentaban otra patología con indicación de cirugía, 8 (21.6%) presentaban dilatación de la aorta ascendente con indicación de reemplazo. Resultados: La mortalidad intrahospitalaria fue de 1/38, 2.7%, por infarto de miocardio perioperatorio. Hubo una reducción significativa en las medianas del gradiente máximo (70 mmHg, IC 95% = 50.03-79.86 vs. 14 mmHg, IC 95% = 11.93-17.5, p < 0.0001) y gradiente medio (45.5 mmHg IC 95% = 30.6-49.68 vs. 7 mmHg, IC 95% = 5.93-9.6, p < 0.0001) de la válvula aórtica cuando comparamos las características basales con los resultados de los primeros 30 días. En una media de 19 (± 8.9) meses de seguimiento la sobrevida fue del 97.3%; la sobrevida libre de reoperación por disfunción valvular, 100% y la sobrevida libre de insuficiencia aórtica ≥ II, 91.9%, respectivamente. Se mantuvo una reducción significativa en las medianas de los gradientes máximo y medio de la válvula aórtica. Conclusiones: La cirugía de reconstrucción de válvula aórtica con pericardio autólogo mostró resultados óptimos en términos de mortalidad, supervivencia libre de reoperación y características hemodinámicas de la neo-válvula.

Patient with unicuspid aortic valve and ascending aorta aneurysm treated with ozaki procedure and ascending aorta replacement

Abstract Although aortic valve replacement remains the gold standard treatment for aortic valve diseases like stenosis (AS) or insufficiency, new surgical methods have been developed with a focus in the reconstruction of the aortic valve rather than replacing it. The Ozaki procedure involves a tailored replacement of each individual valvular leaflet with glutaraldehyde-treated autologous pericardium and aims to reproduce the normal anatomy of the aortic valve. Cases of patients with unicuspid aortic valve treated with the Ozaki procedure are uncommon in the litrature and become even more rare when it comes to concomitant diseases like AS and ascending aorta aneurysm. We present the case of a 21-year-old, fit and asymptomatic male, with unicuspid aortic valve with severe stenosis and ascending aorta dilatation, surgically treated with tricuspidization of the aortic valve with glutaraldehyde-treated autologous pericardium and replacement of the ascending aorta with a straight synthetic graft. Postoperative studies showed a fully functional, neo-tailored tricuspid aortic valve with trivial regurgitation. The patient had an uncomplicated recovery, stayed in the intensive care unit for 2 days and was discharged on the 7th postoperative day.

Feasibility of Complete Aortic Valve Cusp Replacement Using CardioCel® in Early Childhood

The presented case is the report on a successful complete aortic valve cusp replacement using tissue-engineered xenogenic CardioCel® material in early childhood.

Short-term research of aortic valve neo-cuspidization in aortic valve disease: a single center study / 中华胸心血管外科杂志

Objective To determine the feasibility of OZAKI procedure aortic valve neo-cuspidization(AVneo) for the treatment of aortic valve disease in our institution.Methods Twelve consecutive patients from November 2015 to October 2016 received AVneo in our single center are retrospected.Their mean age was(41.3 ± 16.9) years old.There were 11 males and 3 females.3 patients had aortic stenosis and 11 patients had aortic insufficiency.Autologous pericardium was used to reconstruct 3 aortic leaflets independently.The distance between each commissure was measured by a specific sizer to decide the size of each leaflet.Suturing the pericardial leaflets onto each aortic annulus.Results There was no perioperative mortality.No operations converted to prosthetic valve replacement.1 patient experienced IABP therepy for 2 days,for ventricular tachycardia repeatedly happened when cardiac rebeating intraoperation.Echocardiography one week after surgery showed an average maximum flow velocity of aortic valve of(162.9 ± 34.2) cm/s,average peak pressure gradient of(11.1 ± 4.9) mmHg (1 mmHg =0.133 kPa).Except 1 patient had moderate regurgitation after surgery,the rest of 13 patients showed less than mild aortic regurgitation.Conclusion OZAKI procedure AVneo provides good short-term results in patients with various aortic valve disease.

Aortic Valve Reconstruction (AVrC) Using Autologous Pericardium for a Patient with Severe Aortic Stenosis and Chronic Renal Failure Prior to Kidney Transplant Surgery / 日本心臓血管外科学会雑誌

We performed aortic valve reconstruction (AVrC) using autologous pericardium for a patient with severe aortic stenosis and chronic renal failure, prior to kidney transplantation. The patient received kidney transplantation in the early phase after cardiac surgery. The case was a 61-year-old man with severe aortic valve stenosis who received dialysis due to chronic renal failure. We performed AVrC using autologous pericardium for the following reasons. Anticoagulant therapy is not desirable because of the need to perform kidney transplantation in the early phase after cardiac surgery. Implantation of prosthesis was not desirable because the patient requires oral immunosuppression therapy after kidney transplantation. There was no significant postoperative pressure gradient of the aortic valve orifice or aortic valve regurgitation (AR). The patient received kidney transplantation 113 days after surgery. AVrC using autologous pericardium was feasible for aortic stenosis patients in a patient waiting to receive kidney transplantation because anticoagulation therapy is not necessary after AVrC.