Excellent Hemodynamic Performance After Aortic Valve Neocuspidization Using Autologous Pericardium

Ann Thorac Surg. 2021 Jan;111(1):126-133. doi: 10.1016/j.athoracsur.2020.04.108. Epub 2020 Jun 12.

Abstract

Background: Aortic valve neocuspidization (AVNeo) for trileaflet aortic valve reconstruction using autologous pericardium (Ozaki procedure) offers an alternative treatment modality to overcome drawbacks of conventional prosthetic aortic valve replacement.

Methods: Between October 2016 and April 2019, 103 patients underwent surgery. Mean follow-up was 426 ± 270 days. Aortic stenosis was the leading diagnosis in 80 patients (77.7%) and aortic regurgitation in 23 (22.3%), respectively. Mean age was 54.0 ± 16.4 years (range, 13.8-78.5). A bicuspid valve was found in 81 patients (78.6%). Transthoracic echocardiography was performed at discharge and at 6 to 12 months after surgery. During AVNeo surgery valve sizing for an Abbott/St Jude Trifecta bioprosthesis (virtually implanted Trifecta bioprosthesis; St Jude Medical, St Paul, MN) was performed to compare pressure gradients and effective orifice area with published data.

Results: Trileaflet aortic valve reconstruction was achieved in all patients. In 38 patients neocommissures were created (36.9%). Mean cross-clamp time was 135 ± 20 minutes. Four patients underwent reoperation; the overall freedom from reoperation was 96.1%. Echocardiographic 6- to 12-months follow-up after surgery was available in 93.8% of patients and did not show any change in hemodynamic parameters compared with discharge. Comparison between AVNeo and virtually implanted Trifecta Bioprosthesis revealed a significantly lower mean pressure gradient (8.5 ± 3.7 mm Hg vs 10.2 ± 2.0 mm Hg, P < .001) and higher mean effective orifice area (2.2 ± 0.7 cm2 vs 2.1 ± 0.4 cm2, P = .037) for AVNeo.

Conclusions: AVNeo shows low reoperation rates after surgery within the first 2 years. The hemodynamic performance is excellent, and the effective orifice area and mean pressure gradient remain stable within the first year.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency / surgery*
  • Aortic Valve Stenosis / surgery*
  • Autografts
  • Bioprosthesis*
  • Female
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis*
  • Hemodynamics*
  • Humans
  • Male
  • Middle Aged
  • Pericardium / transplantation*
  • Prosthesis Design
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult