Initial results of aortic valve reconstruction using autologous pericardium (Ozaki's procedure)

Hung Ngo Thanh, Huu Nguyen Cong, Nguyen Tran Thuy, Nam Nguyen Hoang, Anh Nguyen Ngoc, Long Luong Hoang, Thinh Do Duc , Thanh Le Ngoc, Hung Doan Quoc

Nội dung chính của bài viết

Tóm tắt

Introduction: This study report the clinical characteristics, surgical indications, surgical technique and initial outcomes of autologous pericardial aortic valve reconstruction using Ozaki’s procedure. Methods: The study included consecutive patients with isolated aortic valve disease who underwent Ozaki’s procedure between June 2017 and December 2019. Aortic valve cups were reconstructed by autologous pericardium using Ozaki’s procedure. Results: Seventy-two patients were enrolled (mean age 52.9 ± 13 years; 53 males) and consisted of 30 aortic stenosis cases, 20 aortic regurgitation cases, and 22 patients with a combination of both 72 patients, a bicuspid aortic valve was present in 20, and 7 patients had infective endocarditis. Surgery was performed via a full or partial sternotomy. The procedure was successful in 70 case, and two patients were converted to prosthetic valve replacement. The aortic cross-clamp time was 106.3 ± 13.8 minutes, cardiopulmonary bypass time was 136.7 ± 18.5 minutes. One patient died of cardiac tamponade in hospital, and two patients underwent reoperation due to bleeding and sternal infection, respectively,  were observed during the follow-up period of 30 days. 1-month postoperative echocardiography revealed that one patient had moderate aortic valve regurgitation, max trans-valvular pressure gradient was 16.1 ± 2.3 mmHg, and aortic valve area was 2.5 ± 0.2 cm ². Conclusions: Aortic valve reconstruction using autologous pericardium by Ozaki’s procedure was feasible, good hemodynamics, and can be applied to all lesions of the aortic valve.

Chi tiết bài viết

Tài liệu tham khảo

1. Manning WJ. Asymptomatic aortic stenosis in the elderly: A clinical review. JAMA - Journal of the American Medical Association. 2013;310(14):1490–7.
2. Czarny MJ, Resar JR. Diagnosis and management of valvular aortic stenosis. Clinical Medicine Insights: Cardiology. 2014;8:15–24.
3. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on valvular heart disease. European Heart Journal. 2003;24(13):1231–43.
4. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation. 2005;111(7):920–5.
5. Otto CM, Prendergast B. Aortic-valve stenosis - From patients at risk to severe valve obstruction. New England Journal of Medicine. 2014;371(8):744–56.
6. Nishimura RA, Otto CM, Bonow RO, Iii JPE, Fleisher LA, Jneid H, et al. 2017 AHA / ACC Focused Update of the 2014 AHA / ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. 2017. 1159–1195 p.
7. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). European Heart Journal. 2012;33(19):2451–96.
8. North RA, Sadler L, Stewart AW, McCowan LME, Kerr AR, White HD. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation. 1999;99(20):2669–76.
9. Cannegieter SC, Rosendaal FR, Briët E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation. 1994;89(2):635–41.
10. Khan SS, Trento A, DeRobertis M, Kass RM, Sandhu M, Czer LSC, et al. Twenty-year comparison of tissue and mechanical valve replacement. Journal of Thoracic and Cardiovascular Surgery. 2001;122(2):257–69.
11. Human P, Zilla P. Characterization of the immune response to valve bioprostheses and its role in primary tissue failure. Annals of Thoracic Surgery. 2001;71(5 SUPPL.):20–3.
12. Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Takatoh M, et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. Journal of Thoracic and Cardiovascular Surgery. 2014;147(1):301–6.
13. Halees Z Al, Shahid M Al, Sanei A Al, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic valve reconstruction with pericardium: A stentless readily available cheap valve? European Journal of Cardio-thoracic Surgery. 2005;28(2):200–5.
14. Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Matsuyama T, et al. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interactive Cardiovascular and Thoracic Surgery. 2011;12(4):550–3.
15. https://avneo.net.
16. Ngo HT, Nguyen HC, Nguyen TT, Le TN, Camilleri L, Doan HQ. Reconstruction of aortic valve by autologous pericardium (Ozaki’s procedure): Single center experience in Vietnam. Asian Cardiovascular and Thoracic Annals. 2020;(1).
17. Nishimura RA, Otto CM, Bonow RO, Iii JPE, Fleisher LA, Jneid H, et al. 2017 AHA / ACC Focused Update of the 2014 AHA / ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. 2017. 1159–1195 p.
18. Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. Journal of Thoracic and Cardiovascular Surgery. 2007;133(5):1226–33.
19. Reuthebuch O, Koechlin L, Schurr U, Grapow M, Fassl J, Eckstein FS. Aortic valve replacement using autologous pericardium: single centre experience with the Ozaki technique. Swiss medical weekly. 2018;148(February):w14591.
20. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, et al. Clinical factors associated with calcific aortic valve disease. Journal of the American College of Cardiology. 1997;29(3):630–4.
21. Koechlin L, Schurr U, Miazza J, Imhof S, Maurer M, Erb J, et al. Echocardiographic and Clinical Follow-up After Aortic Valve Neocuspidization Using Autologous Pericardium. World Journal of Surgery. 2020;44(9):3175–81.
22. Carabello BA, Paulus WJ. Aortic stenosis. The Lancet. 2009;373(9667):956–66.
23. Ozaki S, Kawase I, Yamashita H, Uchida S, Takatoh M, Kiyohara N. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. Journal of Thoracic and Cardiovascular Surgery. 2018;155(6):2379–87.
24. Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Takatoh M, et al. Reconstruction of bicuspid aortic valve with autologous pericardium - Usefulness of tricuspidization. Circulation Journal. 2014;78(5):1144–51.
25. Nguyen DH, Vo AT, Le KM, Vu TT, Nguyen TT, Vu TT, et al. Minimally Invasive Ozaki Procedure in Aortic Valve Disease: The Preliminary Results. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2018;13(5):332–7.
26. Rosseĭkin E V., Kobzev EE, Bazylev V V. Minimally invasive Ozaki technique. Angiology and vascular surgery. 2019;25(3):142.
27. Krane M, Boehm J, Prinzing A, Ziegelmueller J, Holfeld J, Lange R. Excellent Hemodyna