Single-center Experience with the Ozaki Procedure up to 7 Years

Background: Aortic valve neocuspidization (AVneo) using the Ozaki protocol offers a new technique for the treatment of a variety of aortic valve disorders. Despite promising results in the early postoperative period, reports of medium and long-term results are still rare.

Methods: Between November 2016 and September 2024, 174 patients underwent AVneo. Echocardiographic follow-up was obtained at discharge, at 6 and 12 months, and annually thereafter. Endpoints of the study were survival, freedom from reoperation, endocarditis, and the hemodynamic outcome of the AVneo valve.

Results: Mean age was 53 ± 15.9 years (range 13.9–78.5 years). Main indications for AVneo were aortic stenosis in 135 patients (77.6%) and aortic regurgitation in 39 patients (22.4%). Bicuspid valve was observed in 141 patients (81%). Mean follow-up was 4.6 ± 1.8 years (range 0.01–7.4 years). 30-day mortality was 0.6%. Concomitant procedures were performed in 63 patients (36.2%), mainly replacement of the ascending aorta in 39 patients (22.4%), CABG in 9 patients (5.1%), or patent foramen ovale in 9 patients (5.1%). Mean pressure gradients at discharge, 1, 5, and 7 years after AVNeo were 8.4 ± 3.7 mm Hg, 8.22 ± 3.69 mm Hg, 10.89 ± 9.81 mm Hg, and 11.41 ± 6.64 mm Hg, respectively. Mean effective orifice area at discharge, 1, 5, and 7 years after AVneo was 2.3 ± 0.8 cm², 2.0 ± 0.9 cm², and 2.1 ± 0.9 cm², respectively. Mean effective orifice area index at discharge, 1, 5, and 7 years was 1.12 ± 0.4 cm²/m², 1.15 ± 0.36 cm²/m², 0.93 ± 0.38 cm²/m², 1.12 ± 0.40 cm²/m², respectively. Freedom from reoperation due to structural valve deterioration was 99.4 ± 0.01%, 96.2 ± 0.02%, 85.9 ± 0.05%, respectively. 11 patients were reoperated due to endocarditis (total 6.3%, 1.4% per patient-years).

Conclusion: Outcome follow-up up to 7 years after AVneo showed excellent survival and stable hemodynamic parameters.

Publication History

Article published online:
11 February 2025