Approaching Mid-Term Results for Aortic Valve Reconstruction (Ozaki’s Procedure)

Objectives: Aortic valve reconstruction (AVR) with autologous pericardium using the Ozaki technique attracts increasing attention as a new treatment modality for aortic valve pathologies. The current study focuses on hemodynamic and clinical outcome up to 2 years.

Methods: Between October 2016 and September 2019, 114 patients underwent AVR. Mean age was 54.4 ± 16.1 years (range: 13–78 years). A bicuspid aortic valve was present in 91 (79.8%) patients. Aortic stenosis was the most frequent valve pathology (n = 90/78.9%). Independent of the initial bi- or tricuspid valve configuration, trileaflet AVR was performed in all cases. Concomitant cardiac surgical procedures were performed in 46 patients (40.4%). Transthoracic echo (TTE) was obtained prior to the operation, at discharge, 6 and 12 months and 24 months after surgery.

Results: The 30-day mortality rate was 0.9% and the overall survival was 98.2% at 2.8 years. Overall freedom from reoperation at 12 and 24 months was 97.3% ± 0.2 and 97.3% ± 0.2 with a mean freedom from reoperation of 96.5% at 2.8 years. There was no need for permanent pacemaker implantation in any patient.

At discharge TTE, mean pressure gradients were 8.7 ± 3.8 mm Hg and mean effective orifice area (EOA) was 2.2 ± 0.7 cm². These hemodynamic characteristics remain constant at 1-year (mean pressure gradient: 8.9 ± 2 mm Hg; EOA: 2. 1 ± 0.6 cm²) and 2-year (mean pressure gradient: 8.9 ± 3.2 mm Hg; EOA: 1.9 ± 0.4 cm²) follow-up.

Conclusion: The Ozaki technique for trileaflet aortic valve reconstruction using autologous pericardium shows low-reoperation rates within the first 3 years after surgery. Furthermore, excellent hemodynamic results in terms of effective orifice area and pressure gradients remain stable for at least 2 years. Based on our experience the procedure is not associated with the need for permanent pacemakers.