Single Center Experience with Modified Ozaki Procedure in 129 Patients

Background: Aortic Valve Construction (AVC) was introduced by Ozaki in 2010. The precise sizing of the new cusps, along with the placement of commissures, is considered the key to success in this procedure. Our aim is to present our single-center experience with modified AVC using self-made templates and tools.

Methods: We evaluated data from patients who underwent AVC at our institution between April 2018 and September 2023. Patient data were collected prospectively. All patients used a modified sizing technique with specially designed templates and coaptation forceps. Echocardiographic follow-up was conducted at discharge and annually thereafter. Primary endpoints included Major Adverse Cardiac and Cerebrovascular Events (MACCE) and early mortality. Secondary endpoints were freedom from re-operation and late mortality.

Results: A total of 129 patients underwent AVC during this period. The median age was 56 ± 12 years, with 94 (73%) being male. The majority of patients (96%) used autologous tissue (123 patients) or tissue-engineered pericardium (TEP) (5 patients). AVC was performed as an isolated procedure in 72 (56%) cases and as a combined procedure in 57 (44%) cases. Bicuspid valves were predominant (70%). Seven patients (5.4%) had primary endocarditis. The mean cardiopulmonary and cross-clamp times were 122 ± 31 and 88 ± 18 minutes, respectively. In-hospital mortality occurred in 3 out of 129 (2.3%) patients in the total cohort (merely 1 patient with isolated AVC (1.4%)). Two patients required temporary dialysis, and none needed pacemaker implantation. A total of 5 patients (3.9%) required re-operation. Four due to endocarditis at 27 days, 8 months, 9 months, and one year postoperation and one patient underwent re-operation 2 months after the primary operation due to early cusp tear (TEP). The postoperative mean gradients at 0/1/2 years were 4.7/5.4/5.9 mmHg, remaining stable. The mean follow-up period was 24.3 ± 4.6 months, with only 5 patients developing mild aortic regurgitation during the follow-up. Three patients developed thrombosis of one cusp (all with primary bicuspid valves, which were subsequently switched to tricuspid valves), resolving after temporary anticoagulation therapy. Finally, late mortality was reported in 2 patients, both unrelated to valve issues.

Conclusion: Aortic valve construction is a feasible procedure that can provide a good alternative for young patients, especially those with small aortic annuli. The newly designed templates and forceps enable precise measuring and optimal commissure implantation.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024