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Kalezi ZE, Simbila AN, Mongella S, Nkya D, Sharau G, Shonyela F, Mlawi V, Majani N. Outcomes post Ozaki procedure among children with aortic valve disease at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania: a retrospective descriptive study. BMC Cardiovasc Disord 2024; 24:163. [PMID: 38504187 PMCID: PMC10949633 DOI: 10.1186/s12872-024-03829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Aortic valve reconstruction using glutaraldehyde-treated autologous pericardium, also called Ozaki procedure, is a surgical procedure for patients with aortic valve disease. Gratifying results have been reported in adult patients, however, limited published data is available in paediatric population. This study looked at clinical characteristics and early outcomes of children who underwent Ozaki procedure at our Institute. METHODS This was a retrospective descriptive study conducted on children who underwent aortic valve reconstruction at Jakaya Kikwete Cardiac Institute (JKCI) from January 2019 through December 2022. Medical records of these children were reviewed to extract data on demographics, clinical characteristics, redo surgical interventions and survival. RESULTS A total of 10 children underwent Ozaki procedure during the study period. Eight children had severe aortic regurgitation while 2 had severe aortic stenosis preoperatively. All children had either none or trivial aortic regurgitation immediately after surgery. None of them had redone operations throughout the follow-up period. There was no in-hospital mortality, however, one child died one-year after surgery. The mean follow-up period was 1.6 years with the longest follow-up time of 4 years. CONCLUSION Ozaki procedure showed encouraging early results among children with aortic valve disease who underwent surgical repair by this technique. Future studies with larger sample sizes and longer follow up periods to evaluate long-term results in this population are recommended.
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Affiliation(s)
- Zawadi Edward Kalezi
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stella Mongella
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Deogratias Nkya
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godwin Sharau
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Felix Shonyela
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Vivienne Mlawi
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naizihijwa Majani
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Manchester EL, Pirola S, Pirola S, Mastroiacovo G, Polvani G, Pontone G, Xu XY. Aortic valve neocuspidization and bioprosthetic valves: Evaluating turbulence haemodynamics. Comput Biol Med 2024; 171:108123. [PMID: 38354498 DOI: 10.1016/j.compbiomed.2024.108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
Aortic valve disease is often treated with bioprosthetic valves. An alternative treatment is aortic valve neocuspidization which is a relatively new reparative procedure whereby the three aortic cusps are replaced with patient pericardium or bovine tissues. Recent research indicates that aortic blood flow is disturbed, and turbulence effects have yet to be evaluated in either bioprosthetic or aortic valve neocuspidization valve types in patient-specific settings. The aim of this study is to better understand turbulence production in the aorta and evaluate its effects on laminar and turbulent wall shear stress. Four patients with aortic valve disease were treated with either bioprosthetic valves (n=2) or aortic valve neocuspidization valvular repair (n=2). Aortic geometries were segmented from magnetic resonance images (MRI), and 4D flow MRI was used to derive physiological inlet and outlet boundary conditions. Pulsatile large-eddy simulations were performed to capture the full range of laminar, transitional and turbulence characteristics in the aorta. Turbulence was produced in all aortas with highest levels occurring during systolic deceleration. In the ascending aorta, turbulence production is attributed to a combination of valvular skew, valvular eccentricity, and ascending aortic dilation. In the proximal descending thoracic aorta, turbulence production is dependent on the type of arch-descending aorta connection (e.g., a narrowing or sharp bend) which induces flow separation. Laminar and turbulent wall shear stresses are of similar magnitude throughout late systolic deceleration and diastole, although turbulent wall shear stress magnitudes exceed laminar wall shear stresses between 27.3% and 61.1% of the cardiac cycle. This emphasises the significance of including turbulent wall shear stress to improve our comprehension of progressive arterial wall diseases. The findings of this study recommend that aortic valve treatments should prioritise minimising valvular eccentricity and skew in order to mitigate turbulence generation.
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Affiliation(s)
- Emily Louise Manchester
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Department of Fluids and Environment, The University of Manchester, Manchester, United Kingdom.
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Department of BioMechanical Engineering, Delft University of Technology, Delft, Netherlands.
| | - Sergio Pirola
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom.
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Lansakara M, Unai S, Ozaki S. Ozaki procedure-re-construction of aortic valve leaflets using autologous pericardial tissue: a review. Indian J Thorac Cardiovasc Surg 2023; 39:260-269. [PMID: 38093925 PMCID: PMC10713953 DOI: 10.1007/s12055-023-01635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023] Open
Abstract
The Ozaki procedure has emerged as a valuable option for treating various aortic valve pathologies. This review article delves into the intricacies of this innovative surgical approach by exploring its adaptation to the complex anatomy and physiology of the aortic root. The diverse etiologies of aortic valve diseases, ranging from congenital anomalies to degenerative changes, make treatment selection a complex challenge. Aortic valve replacement has traditionally been the gold standard, but emerging evidence supports valve repair techniques, emphasizing the importance of preserving native tissue. Nevertheless, issues like lifelong anticoagulation with mechanical valves and patient-prosthetic mismatch remain. The Ozaki procedure offers a compelling alternative by utilizing autologous pericardium or a tissue substitute to construct new aortic valve leaflets. This technique, standardized by Dr. Ozaki in 2007, provides a customizable and adaptable solution. The article highlights the anatomy of the aortic root, emphasizing the critical role of the sinus of Valsalva and interleaflet triangles in maintaining proper valve function. The procedure's unique adaptation to aortic root dynamics allows for reduced mechanical stress during systole and diastole, mimicking the natural valve's behavior. Furthermore, Ozaki leaflets exhibit promising hemodynamics and reduced risks of complications, such as permanent pacemaker implantation and patient-prosthetic mismatch. The use of autologous pericardium in the Ozaki procedure presents advantages, including enhanced tissue strength, minimal immunogenicity, and reduced risk of immune-mediated calcification. These factors contribute to the longevity and resilience of the reconstructed valve. This comprehensive review aims to shed light on the procedure's intricacies, its alignment with aortic root anatomy and physiology, and its potential as a valuable tool in the armamentarium of aortic surgeons.
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Affiliation(s)
| | - Shinya Unai
- The Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, Aortic Valve Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J4-1, Cleveland, OH 44915 USA
| | - Shigeyuki Ozaki
- Department of Cardiovascular Surgery, Toho University Ohashi Hospital, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515 Japan
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Mikami T, Uchiyama H, Maeda T, Nakashima S, Satoshi M, Taku S, Araki E. A Case of Severe Aortic Stenosis after Aortic Valve Neocuspidization Using Autologous Pericardium ( Ozaki Procedure). Ann Thorac Cardiovasc Surg 2023; 29:261-265. [PMID: 35321992 PMCID: PMC10587478 DOI: 10.5761/atcs.cr.21-00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
A 56-year-old man with a history of left nephrectomy for Wilms' tumor on chronic hemodialysis underwent aortic valve neocuspidization using autologous pericardium (Ozaki procedure) for aortic stenosis (AS) due to a bicuspid aortic valve 6 years ago. The AS gradually progressed and a decrease in the left ventricular ejection fraction was observed. Because of this, we decided to perform reoperative aortic valve replacement using a mechanical valve. Intraoperative findings showed severe calcification at the site where the autologous pericardium was sutured to the annulus. However, the degeneration of the valve leaflets themselves was mild. While excellent mid-term results have been reported for the Ozaki procedure, the long-term results are still unclear. In this case, the annulus was severely calcified, which reduced the mobility of the leaflet. We report the first case of AS progression requiring reoperation in the long-term period after the Ozaki procedure.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Hiroki Uchiyama
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Maeda
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Shinji Nakashima
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Muraki Satoshi
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Sakurada Taku
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Eiji Araki
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
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Lee KFL, Mak KLT, Chen Q, Yam N. Early aortic valve neocuspidization failure due to xenograft leaflet tear in a young adult. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad165. [PMID: 37812218 PMCID: PMC10576632 DOI: 10.1093/icvts/ivad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/04/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
Aortic valve neocuspidization, initially described by Ozaki and colleagues, has become an increasingly popular treatment approach for aortic valve disease in both adult and paediatric populations. We report a case of an 18-year-old man with severe aortic regurgitation who underwent the Ozaki procedure using photo-oxidized bovine pericardium. Around 5 weeks after the surgery, he developed early symptomatic valve failure due to multiple leaflet tears requiring urgent reoperation.
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Affiliation(s)
- Kwok Fai Lucius Lee
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Ka Lun Tony Mak
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Qiang Chen
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Nicholson Yam
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
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K. Awad A, Farahat RA, Reda Gad E, Shaban Abdelgalil M, Hassaballa AS. Does ozaki procedure have a future as a new surgical approach for aortic valve replacement? a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:4454-4462. [PMID: 37663695 PMCID: PMC10473333 DOI: 10.1097/ms9.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/10/2023] [Indexed: 09/05/2023] Open
Abstract
Background In 2014, Ozaki et al. introduced the neo-cuspidation (Ozaki procedure), a new valve from the pericardium, to reduce or even prevent the risk of chronic autoimmune inflammation and subsequent rejection or valve degeneration. Thus, the authors aimed to assess the safety and efficacy of the Ozaki technique in treating aortic valve diseases. Materials and methods A comprehensive search was performed via PubMed, the Cochrane Library, Scopus, and the Web of Science up to 20 February 2022. Random-effects meta-analysis models were employed to estimate the pooled mean and SD or event to the total of the Ozaki procedure. Relevant records were retrieved and analyzed by OpenMeta analyst software. Results A total of 2863 patients from 21 studies were finally included in our analysis. Ac. Ozaki technique showed statistical significance in terms of mean cardiopulmonary bypass time of 148 mins (95% CI 144-152.2, P<0.001), mean aortic cross-clamp time of 112.46 mins (95% CI 105.116, 119.823, P<0.001), reoperation with a low risk of 0.011 (95% CI 0.005, 0.016, P=0.047), conversion to aortic valve replacement with a low risk of 0.004 (95% CI -0.001, 0.008, P=0.392), finally ICU stay (days) and hospital length of stay (days) with a mean of 2.061 days (95% CI 1.535, 2.587, P<0.001) and 8.159 days (95% CI 7.183-9.855, P<0.001), respectively. Conclusion The Ozaki procedure provides a safe surgical technique with low mean cardiopulmonary bypass time and aortic cross-clamp time; moreover, a mean of 2-day-postoperative hospital stay was observed with the Ozaki procedure with a low risk of conversion to aortic valve replacement, reoperation, ICU and hospital stay, and death.
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Affiliation(s)
- Ahmed K. Awad
- Faculty of Medicine
- Assistant Lecturer of Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University
| | | | | | - Mahmoud Shaban Abdelgalil
- Faculty of Medicine
- Assistant Lecturer of Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University
| | - Aly Sherif Hassaballa
- Assistant Lecturer of Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University
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Ríos-Ortega JC, Aranda-Pretell N, Talledo-Paredes L, Dávila-Durand M, Reyes-Torres A, Pérez-Valverde Y, Morón-Castro J. [Aortic valve reconstruction surgery with Ozaki technique: initials results from a single center]. Arch Cardiol Mex 2023; 93:308-317. [PMID: 36800695 PMCID: PMC10406489 DOI: 10.24875/acm.22000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/04/2022] [Indexed: 02/22/2023] Open
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.
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Affiliation(s)
- Josías C. Ríos-Ortega
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud
- Master’s Program in Health Teaching and Research, Nacional University of San Marcos
| | | | | | | | - Andrés Reyes-Torres
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud
| | | | - Julio Morón-Castro
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud
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Callalli-Mattos E, Gonzales-Castro S, Salas-Escobedo G, Ríos-Ortega JC. Ozaki Procedure Plus Aortic Annular Enlargement in an Extremely Narrow Aortic Annulus: A Surgical Challenge. Innovations (Phila) 2023; 18:387-389. [PMID: 37551690 DOI: 10.1177/15569845231190853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
We report a 19-year-old woman with a history of percutaneous aortic valve (AV) balloon valvuloplasty 3 years ago. She was admitted with severe symptomatic AV stenosis with narrow aortic annulus. We decided to perform AV reconstruction with autologous pericardium. However, surgical findings revealed a very narrow AV annulus with a unicuspid valve; therefore, an AV enlargement was added.
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Affiliation(s)
- Edmy Callalli-Mattos
- MINSA, National Hospital Hipolito Unanue, Cardiovascular Surgery Department, Lima, Peru
| | | | | | - Josías C Ríos-Ortega
- MINSA, National Hospital Hipolito Unanue, Cardiovascular Surgery Department, Lima, Peru
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
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Unai S, Ozaki S, Johnston DR, Saito T, Rajeswaran J, Svensson LG, Blackstone EH, Pettersson GB. Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective. J Am Heart Assoc 2023; 12:e027391. [PMID: 36628965 PMCID: PMC9939068 DOI: 10.1161/jaha.122.027391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity-matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28 mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6 years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use.
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Affiliation(s)
- Shinya Unai
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Shigeyuki Ozaki
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Tomohiro Saito
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH,Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
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Todurov B, Mokryk I, Batsak B, Ponych N. Computed tomography-guided aortic valve neocuspidization: details of preoperative assessment and surgical technique. Interdiscip Cardiovasc Thorac Surg 2023; 36:ivac290. [PMID: 36802250 PMCID: PMC9972512 DOI: 10.1093/icvts/ivac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
The original Ozaki technique involves sizing and trimming the neovalve cusps during cross-clamp. It leads to prolongation of the ischaemic time, as compared to standard aortic valve replacement. We use preoperative computed tomography scanning of the patient's aortic root to develop personalized templates for each leaflet. With this method, autopericardial implants are prepared before the initiation of the bypass. It permits maximally adopting the procedure to the patient's individual anatomy and to shorten the cross-clamp time. We present a case of a computed tomography-guided aortic valve neocuspidization and concomitant coronary artery bypass grafting with excellent short-term results. We discuss the feasibility and technical details of the novel technique.
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Affiliation(s)
- Borys Todurov
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
| | - Igor Mokryk
- Corresponding author. Department of Adult Cardiac Surgery, Heart Institute, Str. Bratyslavska 5A, Kyiv 02660, Ukraine. Tel: +380-504710444; e-mail: (I. Mokryk)
| | - Bogdan Batsak
- University Clinic of Taras Shevchenko National University, Kyiv, Ukraine
| | - Nataliya Ponych
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
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Bouhout I, Kalfa D, Shah A, Goldstone AB, Harrington J, Bacha E. Surgical Management of Complex Aortic Valve Disease in Young Adults: Repair, Replacement, and Future Alternatives. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:28-37. [PMID: 35835514 DOI: 10.1053/j.pcsu.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Abstract
The ideal aortic valve substitute in young adults remains unknown. Prosthetic valves are associated with a suboptimal survival and carry a significant risk of valve-related complications in young patients, mainly reinterventions with tissue valves and, thromboembolic events and major bleeding with mechanical prostheses. The Ross procedure is the only substitute that restores a survival curve similar to that of a matched general population, and permits a normal life without functional limitations. Though the risk of reintervention is the Achilles' heel of this procedure, it is very low in patients with aortic stenosis and can be mitigated in patients with aortic regurgitation by tailored surgical techniques. Finally, the Ozaki procedure and the transcatheter aortic valve implantation are seen by many as future alternatives but lack evidence and long-term follow-up in this specific patient population.
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Affiliation(s)
- Ismail Bouhout
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - David Kalfa
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Andrew B Goldstone
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Jamie Harrington
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Emile Bacha
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York.
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Ríos-Ortega JC, Rodríguez-Urteaga Z, Carrasco-Rueda J, Talledo-Paredes L. Attached right aortic valve leaflet causing ischemia and severe regurgitation: Successful repair with Ozaki technique. J Card Surg 2022; 37:2916-2919. [PMID: 35712831 DOI: 10.1111/jocs.16690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/11/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Coronary artery occlusion due to fusion of a leaflet to the sinotubular junction is a rare finding that we should consider in the differential diagnosis of young patients who have aortic regurgitation and angina. PATIENT AND METHOD We present a young female with severe aortic regurgitation due to right coronary fusion who underwent mini-invasive aortic valve reconstruction. RESULTS Postoperative evolution was satisfactory. The patient was discharged on the 5th postoperative day and after 3.5 years of follow-up he remains in functional class I, without anticoagulant treatment and with mild aortic regurgitation. COCNCLUSION The Ozaki technique can be used in patients with aortic regurgitation due to single leaflet dysfunction.
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Affiliation(s)
- Josías C Ríos-Ortega
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud, Lima, Peru
| | | | - José Carrasco-Rueda
- Cardiology Department, National Cardiovascular Institute, EsSalud, Lima, Peru
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Shi T, Gao Z, Li S, Hua Z. Single leaflet reconstruction in paediatric aortic regurgitation using the Ozaki procedure. Cardiol Young 2022; 32:789-93. [PMID: 34334149 DOI: 10.1017/S1047951121003164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Aortic valve repair in children is still a challenge. The aim of this study was to analyse the surgical results of children with aortic regurgitation who underwent single leaflet reconstruction using the Ozaki procedure in our medical centre. METHODS A retrospective study was conducted of nine children with aortic regurgitation who received single leaflet reconstruction from May 2017 to September 2019. Paired t-tests and Wilcoxon signed rank tests were used to compare the data at different time points. RESULTS The median surgical age was 4.7 (3.5, 6.4) years. Eight patients were pre-operatively diagnosed with severe aortic regurgitation, while one had moderate regurgitation. The left ventricles were significantly enlarged, with an average z-score of 3.8. Single leaflet reconstruction was carried out using glutaraldehyde-treated autologous pericardium under the standard Ozaki procedure. The median follow-up was 22 (14, 33) months. There was no post-operative death or re-intervention. One patient had moderate or more aortic regurgitation during the follow-up. The average degree of aortic regurgitation was mild, and the average z-score of the left ventricle decreased to -0.2 in the last follow-up. CONCLUSIONS Single leaflet reconstruction using the Ozaki procedure was an effective surgical method for treating children with aortic regurgitation in our centre with satisfactory short-term results.
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Urganci E, Zimpfer D. Ozaki procedure: Ex vivo simulation. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34787966 DOI: 10.1510/mmcts.2021.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Replacements for diseased aortic valves are limited. Repair of the aortic valve is performed by only a few surgeons. A novel technique of aortic valve reconstruction using autologous pericardium shows promising results. In this video tutorial, we demonstrate the Ozaki procedure using an ex vivo low fidelity simulation.
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Affiliation(s)
- Erhan Urganci
- Cardiovascular Surgery, General Hospital Vienna & Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery Medical University of Vienna Spitalgasse 23, A1090 Vienna, Austria
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15
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Abstract
Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic valvulopathies of various entities (aortic stenosis, aortic regurgitation, aortic valve endocarditis) in both tricuspid and bicuspid aortic valves. Thus, aortic valve neocuspidization with fixed autologous pericardium represents a versatile alternative to complex aortic valve repair, with better hemodynamics compared to biological aortic valve replacement and without the need for lifelong anticoagulation, which characterizes mechanical aortic valve replacement. The authors meticulously describe all the technical steps of this highly reproducible, standardized procedure.
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Affiliation(s)
- Markus Krane
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine
| | - Johannes A Ziegelmüller
- Department of Cardiovascular Surgery, German Heart Center Munich of the Technical University of Munich, Munich, Germany
| | - Arnar Geirsson
- Section of Cardiac Surgery, Yale University School of Medicine
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich of the Technical University of Munich, Munich, Germany
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16
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Pirola S, Mastroiacovo G, Mostardini G, Bonomi A, Guglielmo M, Muscogiuri G, Baggiano A, Montisci A, Pontone G, Polvani G. Preoperative Ozaki technique measures on tridimensional engineered root. J Cardiovasc Comput Tomogr 2021; 16:51-53. [PMID: 34610886 DOI: 10.1016/j.jcct.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aortic valve neocuspidalization (AVNeo) is an innovative surgical technique aiming at the reconstruction of the aortic valve using autologous pericardium. One of the main criticisms to AVNeo is the longer duration of the aortic clamping time (ACT) as compared to standard aortic valve replacement due to the sizing of the valve neocusps. METHODS We retrospectively enrolled 30 consecutives patients underwent AVNeo. For each patient we developed a 3D aortic root model (ARM) based on CT-scan datasets. We retrospectively compared the leaflets measurements performed during surgery with those obtained on the corresponding ARMs. RESULTS In 100% of cases no difference between the in vitro and in vivo measurements exceeded the acceptable error limit of 2 mm. The correlation of each single in vitro versus in vivo measurements demonstrates a strong coincidence between the two different methods of sizing (r > 0,9, p < .0001). By analyzing the data considering the annulus perimeter and not the single cusp size, the perfect coincidence was to be found in 89.9% with a slight acceptable discrepancy (2 mm on total) in the remaining 10.1%. CONCLUSIONS 3D-ARMs, printed from CT-scan, represent a reproducible process to obtain overlapping cusp sizes compared to those measured in-vivo, possibly reducing the ACT.
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Affiliation(s)
- Sergio Pirola
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Italy
| | - Giulia Mostardini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alice Bonomi
- Department of Statistics Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Marco Guglielmo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Andrea Baggiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Andrea Montisci
- Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Italy
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17
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Gardin C, Morciano G, Ferroni L, Mikus E, Tripodi A, Pin M, Tremoli E, Albertini A, Zavan B. Biological Characterization of Human Autologous Pericardium Treated with the Ozaki Procedure for Aortic Valve Reconstruction. J Clin Med 2021; 10:3954. [PMID: 34501402 DOI: 10.3390/jcm10173954] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The Ozaki procedure is an innovative surgical technique aiming at reconstructing aortic valves with human autologous pericardium. Even if this procedure is widely used, a comprehensive biological characterization of the glutaraldehyde (GA)-fixed pericardial tissue is still missing. Methods: Morphological analysis was performed to assess the general organization of pericardium subjected to the Ozaki procedure (post-Ozaki) in comparison to native tissue (pre-Ozaki). The effect of GA treatment on cell viability and nuclear morphology was then investigated in whole biopsies and a cytotoxicity assay was executed to assess the biocompatibility of pericardium. Finally, human umbilical vein endothelial cells were seeded on post-Ozaki samples to evaluate the influence of GA in modulating the endothelialization ability in vitro and the production of pro-inflammatory mediators. Results: The Ozaki procedure alters the arrangement of collagen and elastic fibers in the extracellular matrix and results in a significant reduction in cell viability compared to native tissue. GA treatment, however, is not cytotoxic to murine fibroblasts as compared to a commercially available bovine pericardium membrane. In addition, in in vitro experiments of endothelial cell adhesion, no difference in the inflammatory mediators with respect to the commercial patch was found. Conclusions: The Ozaki procedure, despite alteration of ECM organization and cell devitalization, allows for the establishment of a noncytotoxic environment in which endothelial cell repopulation occurs.
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Krane M, Wirth F, Boehm J, Lange R. Do we need to rethink treatment of aortic valve pathologies in younger patients? Eur J Cardiothorac Surg 2021; 60:46-47. [PMID: 33899098 DOI: 10.1093/ejcts/ezab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Markus Krane
- Department of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research) - Partner Site Munich Heart Alliance, Munich, Germany
| | - Felix Wirth
- Department of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Munich, Germany
| | - Johannes Boehm
- Department of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research) - Partner Site Munich Heart Alliance, Munich, Germany
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19
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Saisho H, Scharfschwerdt M, Schaller T, Reil JC, Ensminger S, Fujita B, Aboud A. An ex vivo evaluation of two different suture techniques for the Ozaki aortic neocuspidization procedure. Interact Cardiovasc Thorac Surg 2021; 33:518-524. [PMID: 34089604 DOI: 10.1093/icvts/ivab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We investigated the Ozaki procedure using a single interrupted suture technique (SST) and compared this with the standard continuous suture technique (CST) with regard to hydrodynamic valve performance. In addition, both techniques were compared with the native aortic valve (NAV). METHODS Effective orifice area, mean pressure gradient and leakage volume were evaluated in the NAV as well as after an Ozaki procedure using SST or CST in fresh swine aortic roots using a mock circulation loop. The NAV, SST and CST were evaluated under 4 defined hydrodynamic conditions. RESULTS Both suture techniques resulted in a similar effective orifice area under all conditions [for stroke volume of 70 ml: SST: 1.50 (1.35-1.87) vs CST: 1.57 (1.41-1.72) cm2, P = 0.8] and there were no significant differences between both suture techniques and the NAV (P > 0.05). Regarding mean pressure gradient, the Ozaki procedure with SST and CST showed no significant differences [7.23 (5.53-8.91) vs 7.04 (6.65-7.60) mmHg, P = 0.72] and there was no significant difference between both suture techniques and the NAV (P > 0.1). In leakage volume, there was no significant difference between SST and CST [4.49 (3.91-4.99) vs CST: 4.23 (3.58-4.87) ml/stroke, P = 0.34]. CONCLUSIONS The Ozaki procedure with SST performed similarly to that with CST with regard to hydrodynamic performance. Our results suggest that the Ozaki procedure can be performed with SST instead of CST, which may be useful in patients with limited surgical exposure, such as a small annulus.
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Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Jan Christian Reil
- University of Lübeck, Lübeck, Germany.,Department of Medicine II, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
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20
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Raju V, Padmanabhan C, Baird CW. Alternative Uses of the Ozaki Technique: Aortic Valved Conduit in a Bentall Operation and Right Ventricle-to-Pulmonary Artery Conduit. World J Pediatr Congenit Heart Surg 2021; 12:406-410. [PMID: 33942692 DOI: 10.1177/2150135121995461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The modified Ozaki technique within a conduit is reproducible and is an alternative to the use of homografts and commercially available conduits which may have special appeal in a low resource setting.
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Affiliation(s)
- Vijayakumar Raju
- Department of Cardiac Surgery, 29904G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Chandrasekar Padmanabhan
- Department of Cardiac Surgery, 29904G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Christopher W Baird
- Cardiac Surgery, Harvard Medical School, 1862Boston Children's Hospital, MA, USA
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21
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Komarov RN, Puzenko DV, Isaev RM, Belov IV. [Prosthetic repair of aortic valve cusps with autopericardium in children. State of the art and prospects]. Angiol Sosud Khir 2021; 27:191-198. [PMID: 33825748 DOI: 10.33529/angio2021119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.
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Affiliation(s)
- R N Komarov
- Department of Hospital Surgery of the Medical Faculty, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia; Department of Faculty Surgery #1, Institute of Clinical Medicine, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia; Department of Cardiosurgery, University Clinical Hospital #1, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - D V Puzenko
- Department of Cardiosurgery, University Clinical Hospital #1, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - R M Isaev
- Department of Hospital Surgery of the Medical Faculty, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia; Department of Faculty Surgery #1, Institute of Clinical Medicine, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - Iu V Belov
- Department of Hospital Surgery of the Medical Faculty, I.M. Sechenov First Moscow Medical University of the RF Ministry of Public Health, Moscow, Russia; Institute of Cardioaortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
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22
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Komarov R, Kurasov N, Ismailbaev A, Tlisov B, Danachev A, Simonyan A, Ivashov I. Aortic homograft implantation after Ozaki procedure: Case report. Int J Surg Case Rep 2021; 81:105782. [PMID: 33752029 PMCID: PMC8010641 DOI: 10.1016/j.ijscr.2021.105782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/05/2022] Open
Abstract
Aortic valve reconstruction with autologous pericardium has shown good results. The infective endocarditis incidence data after Ozaki procedure are rare. Homograft is an optimal replacement option for this patient cohort. This is the first case of homograft use after previous Ozaki procedure.
Introduction and importance The infective endocarditis incidence data for patients undergoing aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium (Ozaki procedure) are rare, and the optimal surgical treatment strategy remains unclear. Case presentation This is the first case report of surgical treatment of infective endocarditis of aortic valve with cryopreserved homograft in an athlete with previously performed Ozaki procedure. Clinical discussion The choice of homograft was dictated by the young age of the patient; professional activity as an athlete; refusal of anticoagulants and the need for wide excision of compromised tissues to mitigate potential risk of spread of infection as well as its recurrence. Conclusion The use of the aortic homograft allowed us to radically remove the infected tissues and achieve hemodynamic characteristics similar to the native valve. This is probably the first case report of use of homograft to treat aortic valve endocarditis following Ozaki procedure.
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Affiliation(s)
- Roman Komarov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Nikolay Kurasov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Alisher Ismailbaev
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Boris Tlisov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Alexander Danachev
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Ashot Simonyan
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Ivan Ivashov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.
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Abstract
The Ozaki operation is currently considered to be a sufficiently known surgical procedure performed in aortic valve defects. Despite satisfactory results in the mid-term period after neocuspidalization, there have been reported cases of pronounced aortic insufficiency due to rupture of neocusps or their endocarditis. Transcatheter aortic valve replacement is a rapidly developing trend at the junction of modern cardiac surgery and interventional cardiology, expansively covering groups of patients at high, moderate and recently also low surgical risk. Repeat open cardiosurgical interventions remain a zone of especially increased risk of complications. This clinical case report describes technical aspects and immediate outcomes of successful transcatheter implantation of aortic valve prosthesis in a patient with aortic insufficiency revealed 2 years after the Ozaki procedure.
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Affiliation(s)
- V V Bazylev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - A B Voevodin
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - D A Radzhabov
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - Ia S Slastin
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
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Bernhardt L, Sogomonian R, Sood A, Hammons L, Haftevani EA, Gowda RM. Ozaki procedure complicated by postpericardiotomy syndrome and cardiac tamponade. Future Cardiol 2020; 17:301-307. [PMID: 32945199 DOI: 10.2217/fca-2020-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic valve replacement has long been the standard of care for many aortic valve diseases. Neo sinus reconstruction and aortic valve reconstruction with native pericardium, known as the Ozaki procedure, is a relatively new technique with early studies showing good mid-term durability and hemodynamics without the need for life-long anticoagulation. We present the case of a 56-year-old male presenting with aortic valve endocarditis and severe aortic insufficiency who underwent successful aortic valve reconstruction via the Ozaki procedure complicated by postpericardiotomy syndrome and cardiac tamponade. Although the Ozaki procedure is a promising alternative to conventional aortic valve replacement, further study is needed to determine long-term re-operation rates, stability and mortality.
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Affiliation(s)
- Logan Bernhardt
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, NY, 10003, USA
| | - Robert Sogomonian
- Department of Cardiovascular Diseases, Mount Sinai Heart at Mount Sinai Beth Israel, NY, 10003, USA
| | - Abhinav Sood
- Department of Cardiovascular Diseases, Mount Sinai Heart at Mount Sinai Beth Israel, NY, 10003, USA
| | - Lindsay Hammons
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, NY, 10003, USA
| | | | - Ramesh M Gowda
- Department of Cardiovascular Diseases, Mount Sinai Heart at Mount Sinai Beth Israel, NY, 10003, USA
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25
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Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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26
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Takahashi Y, Shibata T, Sakaguchi M, Fujii H, Morisaki A, Sakon Y, Yamane K, Kishimoto N, Murakami T. Concomitant operation for pulmonary artery aneurysm and pulmonary valve regurgitation. Gen Thorac Cardiovasc Surg 2020; 68:855-857. [PMID: 32040820 DOI: 10.1007/s11748-020-01315-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
A 48-year-old man with a pulmonary artery aneurysm was referred to our hospital. Enhanced computed tomography revealed an aneurysm extending from the main trunk to the bilateral pulmonary branch (maximum diameter 6.4 cm) of the artery. Echocardiography revealed moderate pulmonary valve (PV) regurgitation with right ventricle dilatation. Surgery was indicated because of the pulmonary aneurysm and dyspnea on exertion due to moderate PV regurgitation. Intra-operatively, two cusps were found to be normal in shape, whereas a third left-facing cusp was thick and resembled a small ridge. Therefore, we created one neo-cusp with autologous pericardium using a custom-made template and sutured it along a new, predetermined annulus. We then replaced the pulmonary aneurysm with a T-shaped artificial graft. Postoperative echocardiography showed satisfactory movement of the neo-cusp without pulmonary regurgitation and reduced right ventricular size.
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Affiliation(s)
- Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan.
| | - Masanori Sakaguchi
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Kokoro Yamane
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Noriaki Kishimoto
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City University Postgraduate School of Medicine, 1-4-3, Asahimachi,Abeno, Osaka, 545-8585, Japan
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27
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Baird CW, Marathe SP, Del Nido PJ. Aortic valve neo-cuspidation using the Ozaki technique for acquired and congenital disease: where does this procedure currently stand? Indian J Thorac Cardiovasc Surg 2020; 36:113-122. [PMID: 33061192 PMCID: PMC7525707 DOI: 10.1007/s12055-019-00917-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022] Open
Abstract
The surgical treatment options for pediatric aortic valve disease are limited. The Ozaki procedure, which involves templated creation of new aortic valve leaflets, has proved to be a promising surgical technique. This review aims at elaborating the indications, technical intricacies, and outcomes of the aortic valve neo-cuspidization procedure (Ozaki procedure) in the pediatric population.
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Affiliation(s)
| | | | - Pedro J Del Nido
- Boston Children's Hospital, Harvard Medical School, Boston, MA USA
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Cuttone F, Alacoque X, Leobon B, Karsenty C, Guitarte A, Dulac Y, Chausseray G, Acar P, Hadeed K. Aortic valve reconstruction in children: A new string to our bow. Arch Cardiovasc Dis 2019; 112:653-656. [PMID: 31708440 DOI: 10.1016/j.acvd.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Fabio Cuttone
- Congenital Cardiac Surgery, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France.
| | - Xavier Alacoque
- Department of Congenital Cardiac Anaesthesiology, CHU de Toulouse, 31059 Toulouse, France
| | - Bertrand Leobon
- Congenital Cardiac Surgery, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - Clement Karsenty
- Congenital Cardiology, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - Aitor Guitarte
- Congenital Cardiology, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - Yves Dulac
- Congenital Cardiology, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - Gerald Chausseray
- Department of Congenital Cardiac Anaesthesiology, CHU de Toulouse, 31059 Toulouse, France
| | - Philippe Acar
- Congenital Cardiology, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - Khaled Hadeed
- Congenital Cardiology, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
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