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
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 28, 2021
Footnotes
Funding: None.
Conflicts of Interest: The Japanese Organization for Medical Device Development (JOMDD) has contributed to helping fund the Ozaki/AVNeo registry.
IRB approval: Ozaki Procedure Aortic Valve Reconstruction Registry (IRB-P00026715 dated 5th December 2017). The need for written informed consent was waived.
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- Commentary: What is the Sound of One Hand Clapping?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
- PreviewThose 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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