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Single-Leaflet Aortic Valve Reconstruction Utilizing the Ozaki Technique in Patients With Congenital Aortic Valve Disease

Published:October 28, 2021DOI:https://doi.org/10.1053/j.semtcvs.2021.10.009
      Evaluate outcomes of single leaflet aortic valve reconstruction using Ozaki sizer and template. Single institute retrospective analysis between August 2015 and August 2019. Thirty-three patients, median age 9.3 years and weight 29.2 kg underwent single leaflet Ozaki repair. Preoperative indications were: AR (n = 17), AS (n = 3) or AS/AR (n = 13). Baseline anatomy was unicuspid (n = 15), bicuspid (n = 9) or tricuspid (n = 9). Two patients had endocarditis. Prior interventions included balloon valvuloplasty (n = 22) and aortic valve repair (n = 9). Pre-op average native annulus diameter was 19.6 mm and peak echo gradient was 36 mm Hg. Autologous pericardium, Photofix and CardioCel bovine pericardium were used in 26, 5, and 2 patients. Non-coronary sinus enlargement was required in 3 and aortic root reduction in 9 patients. Single leaflet reconstruction was done for the right coronary cusp (n = 25), non-coronary cusp in (n = 6) and left coronary cusp (n = 2). Additional procedures were done in 30 patients. Median ICU and hospital LOS were 2.1 and 6.3 days. There were no early re-interventions or conversions to valve replacement and one unrelated mortality.en At discharge, all patients had < moderate AR and/or AS with average peak gradients of 15 mm Hg. The median follow-up was 1.1 year, (IQR 0.7–1.8 years). Freedom from ≥ moderate AR and AS at 2 years was 76% and 86%. One patient required surgical re-intervention for severe AR 1.5 years after surgery for inflammatory infiltrate with calcification and fibrosis. Single-leaflet aortic valve leaflet reconstruction utilizing the Ozaki technique has promising early results and can be considered in patients when there are acceptable native leaflets.

      Graphical Abstract

      Keywords

      Abbreviations:

      AR (aortic regurgitation), AS (aortic stenosis), AVNeo (aortic valve neo-cuspidization), BSA (body surface area), CPB (cardiopulmonary bypass), ICU (intensive care unit), JOMDD (Japanese Organization for Medical Device Development, Inc.), LOS (length of stay), LVEDV (left ventricular end-diastolic volume), LVEDVz (Z score of left ventricular end-diastolic volume), RV (right ventricle), PA (pulmonary artery)
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      Linked Article

      • Commentary: What is the Sound of One Hand Clapping?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
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          Those fortunate enough to have heard Shigeyuki Ozaki describe the inception of his eponymous procedure will recall his frequent reference to “prayer hands” as an illustration of the intentional redundancy along the zone of coaptation that is created by using the (oversized) leaflet stencils. While speculative, some have suggested that this design may serve additionally to provide adjustment for annular growth or leaflet restriction while still maintaining valvar competence. In part because of this, Ozaki's experience in adults has engendered enthusiasm for extension of this technique to children, albeit with variable results and very modest follow-up.
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